The  Influence  of  Water-Drinking  with 

Meals  upon  the  Digestion  and 

Utilization  of  Proteins,  Fats 

and  Carbohydrates 


By  HLNRY  ALBRIGHT  MATT1LL 


A.B.  Western  Reserve  University,  1906 
A.M.  Western  Reserve  University,  1907 


THESIS 


SUBMITTED    IN    PARTIAL    FULFILMENT   OF   THE    REQUIREMENTS    FOR    THE    DEGREE 

OF    DOCTOR    OF    PHILOSOPHY   IN    PHYSIOLOGICAL   CHEMISTRY    IN    THE 

GRADUATE    SCHOOL   OF   THE   UNIVERSITY   OF   ILLINOIS 


IQIO 


EASTON,  PA.: 

ESCHENBACH  PRINTING  COMPANY 
1911 


The  Influence  of  Water-Drinking  with 

Meals  upon  the  Digestion  and 

Utilization  of  Proteins,  Fats 

and  Carbohydrates 


By  HENRY  ALBRIGHT  MATTILL 


A.B.  Western  Reserve  University,  1906 
A.M.  Western  Reserve  University,  1907 


THLSI5 


SUBMITTED   IN    PARTIAL   FULFILMENT  OF  THE   REQUIREMENTS   FOR   THE   DEGREE 

OF   DOCTOR    OF   PHILOSOPHY   IN   PHYSIOLOGICAL  CHEMISTRY   IN   THE 

GRADUATE   SCHOOL   OF  THE   UNIVERSITY   OF  ILLINOIS 


IQIO 


EASTON,  PA.: 

KSCHENBACH  PRINTING  COMPANY 
1911 


STUDIES  ON  WATER  DRINKING.  VIII.1    THE  UTILIZATION  OF 

INGESTED  FAT  UNDER  THE  INFLUENCE  OF  COPIOUS 

AND  MODERATE  WATER  DRINKING  WITH  MEALS. 

BY  H.  A.  MATTILI,. 

Introduction. 

Current  Theories. — Notwithstanding  the  fact  that  many  persons  are 
accustomed  to  drinking  considerable  amounts  of  water  with  their  meals, 
and  with  no  apparent  ill  effect,  the  opinion  has  been  and  still  is  somewhat 
general,  and  the  statement  almost  axiomatic,  that  the  use  of  water  with 
meals  is  injurious  and  harmful.  The  arguments  advanced  in  proof  of 
this  statement  are  typical  of  that  quasi-scientific  reasoning  which  assumes, 
a  priori,  the  truth  of  certain  antecedents ;  the  consequents  must  therefore 
logically  be  true. 

A  concrete  statement  of  the  views  as  generally  held  by  many  in  the 
medical  profession  and,  through  them,  by  the  general  public,  may  be 
cited  from  Carrington  i2 

"We  can  lay  down  the  definit  and  certain  rule  that  it  (water)  should 
never  be  drunk  at  meals,  and  preferably  not  for  at  least  one  hour  after 
the  meal  has  been  eaten.  The  effect  of  drinking  water  while  eating  is, 
first,  to  artificially  moisten  the  food,  thus  hindering  the  normal  and 
healthful  flow  of  saliva  and  the  other  digestive  juices;  secondly,  to  dilute 
the  various  juices  to  an  abnormal  extent;  and  thirdly,  to  wash  the  food 
elements  through  the  stomach  and  into  the  intestins  before  they  have 
had  time  to  become  thoroughly  liquefied  and  digested.  The  effects  of 
this  upon  the  welfare  of  the  whole  organism  can  only  be  described  as 
direful." 

It  needs  no  argument  to  prove  that  such  effects  upon  the  organism 
would  be  direful,  but  the  proof  that  such  effects  follow  the  drinking  of 
water  with  meals  is  entirely  wanting.1  On  the  contrary,  experiments 
have  been  made  which  show  specifically  that  certain  of  these  effects  do 
not  follow. 

1  Presented  in  abstract  at  the  New  Haven  meeting  of  the  American  Society  of 
Biological  Chemists,  December,  1910;  Proceedings,  Vol.  II,  p.  xiv.     This  paper  and  the 
two  following  were  presented  in  abstract  before  the  Second  International  Congress  of 
Alimentary  Hygiene  and  of  the  Rational  Feeding  of  Man,  Brussels,  October,  1910; 
Proceedings,  Vol.  I,  Section  II,  p.  30.    They  were  also  presented  by  Mr.  Mattill  to  the 
Graduate  School  of  the  University  of  Illinois,  in  partial  fulfilment  of  the  requirements 
for  the  degree  of  Doctor  of  Philosophy. 

2  Although  little  experimental  evidence  substantiates  the  statement  it  will  be 
granted  at  the  start,  that  any  circumstance  that  induces  insufficient  mastication  of  the 
food  before  swallowing  is  undesirable,  the  reason  being  that  salivary  digestion  in  the 
stomach  is  not  to  be  overlooked  and  further,  that  the  movements  of  the  alimentary 
tract  are  insufficient  to  bring  about  the  necessary  fineness  of  division  of  the  food  par- 
ticles.    Therefore  in  all  the  discussion  and  experimental  work  that  follows,  water  with 
meals  means  the  taking  of  water  when  the  mouth  is  empty;  the  food  is  masticated, 
as  usual  without  the  aid  of  water;  water  is  never  used  to  wash  down  the  products  of 
incomplete  mastication. 

251861 


4  STUDIES   ON   WATER   DRINKING.      VIII. 

i.  The  Effect  of  Water  on  the  Digestive  Juices.  Saliva. — The  degree  of 
dryness  of  the  food  determins  the  amount  of  saliva  poured  out  upon  it, 
the  drier  the  food  the  larger  the  amount  of  saliva  that  is  secreted.2  The 
kind  of  food  introduced  into  the  mouth  determins  also  the  physical 
properties  of  the  saliva.  It  will  be  argued,  therefore,  that  the  taking  of 
water  with  food  prevents  the  normal  secretion  of  saliva.  In  the  experi- 
ments that  follow,  however,  since  water  is  not  mixed  with  the  food  while 
this  is  in  the  mouth,  the  effect  of  water  on  the  secretion  of  saliva  is  only 
a  residual  one,  that  is,  an  effect  due  to  the  presence  of  whatever  water 
may  remain  in  the  mouth  after  swallowing. 

Gastric  Juice. — The  influence  of  water  upon  gastric  secretion  was  in- 
vestigated by  Pavlov  and  Khizhin3  and  still  earlier  by  Heidenhain*0 
and  by  Sanotskii36  and  their  findings  have  been  confirmed  by  later  in- 
vestigators, especially  by  Foster  and  Lambert.4  The  first  mentioned 
workers  in  experiments  on  dogs  with  Pavlov  stomachs  and  divided  vagi 
showed  that  water  stimulates  the  flow  of  gastric  juice  if  comparatively 
large  amounts  (400-500  cc.)  are  ingested,  but  that  with  small  amounts 
(100-150  cc.)  in  half  the  cases  observed,  not  the  least  trace  of  secretion 
could  be  found.  "It  is  only  a  prolonged  and  widely  spread  contact 
of  the  water  with  the  gastric  mucous  membrane,  which  gives  a  constant 
and  positive  result."3  Since  the  vagi  were  divided,  the  effect  of  the 
water  must  have  been  that  of  a  chemical  excitant.  The  later  investi- 
gators4 in  experiments  on  the  influence  of  water  when  taken  with  food 
showed  that  water  causes  not  only  a  more  voluminous  secretion  but  also 
a  more  acid  secretion. 

Pancreatic  Jwce  and  Bile. — Water  also  acts  as  an  excitant  of  pancreatic 
juice.5  When  150  cc.  of  water  are  introduced  into  the  stomach  of  a  dog 
the  pancreas  begins  to  secrete,  or  augments  its  flow,  within  a  few  minutes 
after  the  water  has  entered  the  stomach.  Since  this  amount  of  water, 
according  to  Pavlov,  is  insufficient  to  excite  a  flow  of  gastric  juice,  the 
secretion  of  pancreatic  juice  is  not  secondary  to  a  secretion  of  the  other, 
but  is  a  direct  result  of  the  presence  of  water  hi  the  stomach.  In  dogs 
with  Pavlov  pancreas  fistulas  Togami*  has  shown  that  in  response  to  both 
chemical  and  psychical  stimuli  there  is  evident  parallelism  between  the 
secretion  of  gastric  juice  and  of  pancreatic  juice.  Acids  of  all  kinds  act  as 
powerful  excitants  of  pancreatic  secretion.  The  flooding  of  the  small  in- 
testin  with  larger  amounts  of  acid  chyme  means  an  increased  production 
of  pancreatic  secretion  and  a  consequent  increased  flow  of  pancreatic  juice. 
The  biliary  secretion  has  also  been  shown  to  respond  to  pancreatic  secre- 
tion and  the  digestive  properties  of  the  pancreatic  juice  are  augmented 
in  a  very  marked  way  by  the  bile.  Hence  the  increased  acidity  of  the 
gastric  contents  as  a  result  of  the  stimulating  action  of  water  causes  a 
much  more  active  digestive  juice  to  be  poured  out  upon  the  chyme  as  it 
reaches  the  intestin.  Furthermore,  certain  other  experiments  from  this 


STUDIES  ON  WATER  DRINKING.       VIII.  5 

laboratory  have  shown  increased  pancreatic  activity8"  to  follow  water- 
drinking  with  meals,  the  index  being  the  output  of  fecal  amylase.7'  7o 

Intestinal  Juice. — The  effect  of  water  in  the  intestin  has  not  been 
demonstrated  as  clearly  as  its  effect  in  the  middle  portion  of  the  alimentary 
canal.  Under  ordinary  circumstances  the  intestinal  juice  is  secreted 
only  by  those  portions  of  the  tube  with  which  the  food  is  in  contact. 
Mechanical  stimulation  is  effective  in  producing  a  secretion  but  it  is  shown 
that  such  secretion  is  comparatively  poor  in  enzymes  and  contains  only 
salt  and  water.  When  poured  out  upon  food  the  intestinal  juice  is  rich 
in  enterokinase,  but  much  more  powerful  stimulants  even  than  food  in 
this  regard  are  the  pancreatic  enzymes;  which  one  of  them  is  active  in 
this  direction  is  not  yet  known. 

2.  The  Effect  of  Dilution  upon  Enzyme  Activity. — The  reactions  brought 
about  by  enzymes  are  like  all  other  chemical  reactions  in  that  they  are 
reversible.     They  do  not  proceed   to   completion   unless   the  products 
of  the  reaction  are  removed  as  formed.     In  a  concentrated  solution  the 
point  at  which  the  reaction  comes  to  a  standstill  is  reached  sooner  than  in  a 
dilute  one,  and  in  many  instances  the  equilibrium  of  a  reaction  mixture 
may  be  disturbed  by  dilution;  the  reaction  is  forced  toward  completion 
if  water  is  added.     In  the  light  of  this  fact  the  increased  activity  of  gastric 
juice  that  has  been  observed  under  the  influence  of  water  may  be  due 
to  the  effect  of  dilution  fully  as  much  as  to  the  increased  acidity  that 
accompanies  it. 

3.  The  Rapidity  of  the  Passage  of  Food  as  Affected  by  Water. — That 
water  begins  to  pass  the  pylorus  soon  after  its  ingestion  has  been  shown 
by  von  Mering.8     To  a  large  dog  with  duodenal  fistula  500  cc.  of  water 
were  given  through  the  mouth;  within  25  minutes  495  cc.  were  collected 
through  the  fistula.     It  is  probable  that  when  water  ingestion  is  accom- 
panied by  the  taking  of  food  the  passage  of  water  is  somewhat  delayed. 
In  the  experiments  to  be  described  it  was  shown  that  the  equivalents  of  from 
one-half  to  three  fourths  of  the  amount  of  water  ingested  during  a  meal,  if 
this  amount  was  large,  may  be  voided  in  the  urine  within  45-90  minutes 
thereafter.     These  facts  would  seem  to  give  some  ground  for  the  conten- 
tion that  the  food  elements  might  be  washed  through  the  stomach  and 
into  the  intestin  before  they  were  properly  liquefied  and  digested. 

It  has  been  shown  by  Cohnheim80  however  that  when  the  fundus  is 
filled  with  food  material  a  specific  mechanism  comes  into  play  after  the 
introduction  of  liquid.  Along  the  smaller  curvature  there  is  formed  a 
trough  which  connects  the  antrum  pylori  with  the  cardiac  opening,  and 
this  trough  has  been  demonstrated  anatomically  by  Kaufmann.86  In 
this  trough  water  flows  past  the  bolus  of  food  lying  hi  the  stomach  without 
as  much  as  washing  any  of  the  exterior  away.  Even  when  digestion 
is  at  its  height  and  when  gastric  juice  is  being  secreted  in  large  amounts, 
almost  neutral  water  is  often  found  leaving  the  stomach.  Cohnheim 


6  STUDIES   ON   WATER   DRINKING.      VIII. 

further  states  that  there  is  no  dilution  01  tne  stomach  contents  by  liquid 
food,  and  the  accurate  regulation  of  the  pyloric  sphincter  is  not  disturbed 
whether  water  is  taken  with  the  meal  or  not. 

From  the  considerations  thus  briefly  reviewed  the  facts  regarding  the 
drinking  of  water  with  meals  seem  to  be  the  following:  (i)  The  ingestion 
of  large  amounts  of  water  with  meals  not  only  does  not  hinder  the  normal 
flow  of  digestive  juices,  but  acts  as  an  excitant  to  their  flow;  (2)  the 
digestive  juices  are  not  made  less  efficient  by  dilution;  on  the  contrary, 
enzyme  action  is  more  complete  the  greater  the  dilution,  within  limits; 
(3)  while  the  food  elements  might  perhaps  be  washed  through  the  stomach 
into  the  intestin  more  rapidly  than  is  usual  (contrary  to  Cohnheim's 
belief),  yet  over  against  this  is  the  greater  amount  and  efficiency  of  the 
digestive  juices.  The  first  two  conclusions  have  been  substantiated  by 
experiment.  The  question  as  to  the  completeness  of  the  digestion  of  the 
food  and  the  degree  to  which  it  is  utilized  under  the  conditions  of  greater 
dilution  and  supposedly  more  rapid  movement  through  the  alimentary 
canal  has  had  but  little  consideration. 

The  only  experimental  evidence  upon  the  utilization  of  the  fat  of  food 
as  influenced  by  the  amount  of  water  taken  with  meals  comes  from  an 
investigation  by  Ruzicka.9  His  conclusions  were  drawn  from  data  ob- 
tained in  two  experimental  periods  of  two  days  each,  on  a  bread  and 
meat  diet,  preceded,  separated  and  followed  by  a  day  of  milk  diet.  No 
attempt  was  made  to  have  the  fat  intake  uniform  from  day  to  day.  Dur- 
ing the  first  period  water  was  taken  at  times  and  in  amounts  found  de- 
sirable, except  that  none  was  taken  during  or  immediately  following  a 
meal.  In  the  second  period  approximately  the  same  amount  of  water 
was  ingested  but  it  was  taken  during  and  immediately  following  the  meals. 
The  feces  data  include  dry  matter,  nitrogen,  fat,  ash,  and  carbohydrate 
by  difference.  Simple  ether  extraction  was  employed  in  determining 
fat.  The  balance  of  utilization  was  94.5  per  cent,  in  the  first  period  as 
against  95.1  per  cent,  in  the  second.  The  author  draws  the  negative 
conclusion  that  a  moderate  water  ingestion  at  meal  time  has  no  harmful 
influences  on  the  utilization  of  the  food.  He  emphasizes  the  adaptability 
of  the  organism  and  supposes  that  it  is  a  matter  of  the  rapid  absorption 
of  the  superfluous  water.  More  specific  conclusions  than  these  were 
hardly  justified,  since  neither  diet  nor  water  ingestion  was  absolutely 
uniform  as  to  time  and  amount,  the  water  ingestion  being  particularly 
variable;  it  ranged  from  300  to  522  cc.  at  meal  time. 

The  Fetes. — The  nature  and  composition  of  human  feces  seems  generally 
to  be  misunderstood.  A  recent  statement  is  that  the  feces  are  chiefly 
the  unabsorbed  residues  of  intestinal  excretions.10  Another  statement 
is  to  the  effect  that  the  feces  consist  chiefly  of  bacteria.100  A  micro- 
scopical examination  easily  shows,  however,  that  these  claims  are  not 
true.  The  composition  of  feces  as  given  by  Schmidt  and  Strasburger11 
is  as  follows : 


STUDIES  ON  WATER  DRINKING.      VIII.  7 

(1)  Indigestible  material  in  the  food. 

(2)  Undigested  material,  which  has  for  some  reason  escaped  the  action 
of  the  digestive  juices. 

(3)  Residues  of  the  digestive  juices. 

(4)  Bacteria  and  the  products  of  fermentation  and  putrefaction. 

(5)  Products  of  the  epithelial  wall,  such  as  decayed  cells,  leucocytes, 
etc. 

Fats  are  almost  always  found  in  feces,  the  amount  being  increased 
by  an  increase  in  the  fats  in  the  food.  In  addition  to  the  food  as  a  source 
of  fat  are  the  digestive  juices  and  the  cells  of  the  alimentary  epithelia 
which  contain  both  fats  and  lipoids. 

Many  investigators  believe  that  the  percentage  utilization  of  a  given 
foodstuff  in  an  available  diet  is  a  subject  whose  importance  has  been 
exaggerated.  It  is  said  that  the  percentage  differences  are  so  small  as 
to  be  inconsiderable,  particularly  in  view  of  the  fact  that  only  small 
quantities  of  a  given  substance  are  involved.  Perhaps  from  the  stand- 
point of  the  mere  existence  of  the  organism  this  may  be  true,  but  the 
question  of  continued  efficiency  is  not  a  negligible  one.  It  seemed  prob- 
able, at  least,  that  an  examination  of  the  feces  with  regard  to  their  con- 
tent of  fat  might  give  an  indication  as  to  the  efficiency  with  which  the 
fat  of  the  food  was  digested  under  the  influence  of  water  ingestion  with 
meals. 

Description. 

General  Plan. — The  general  plan  of  these  experiments  was  to  determin 
in  a  preliminary  period  the  digestibility  of  fat  in  subjects  living  on  a  uni- 
form diet.  During  a  second  period,  with  no  change  in  diet,  a  given  volume 
of  water  was  to  be  added  to  that  taken  normally  with  each  meal,  and  in 
a  final  period  the  conditions  of  the  preliminary  period  should  again  obtain. 

The  subjects  of  the  experiments  were  normal  men,  on  the  staff  of 
assistants  in  the  Department  of  Chemistry.  The  daily  periods  began 
and  ended  at  7  A.M.,  and  the  program  was  as  follows:  Body  weights 
were  taken  at  7  A.M.,  after  urinating  and  defecating.  So  regular  the 
routine  became  that  in  only  two  or  three  instances  throughout  the  eight 
to  nine  weeks  of  the  experiments  defecation  did  not  come  at  this  time. 
To  insure  accuracy,  body  weights  were  always  taken  without  clothing. 
The  morning  meal  was  taken  at  7.30,  the  noon  meal  at  12  or  12.15,  and 
the  evening  meal  at  5.30  or  5.45.  The  three  meals  were  identical  and 
consisted  of  graham  crackers,  butter,  peanut  butter,  milk  and  water. 
Smaller  quantities  of  water  were  taken  at  stated  hours  during  the  day. 
The  men  went  about  their  duties  as  usual  throughout  the  day  and  eve- 
ning. 

The  urine  was  collected  in  24-hour  samples,  the  last  portion  being  that 
passed  before  weighing  in  the  morning.  The  urine  was  analyzed  for  total 


8  STUDIES  ON   WATER   DRINKING.      VIII. 

nitrogen,  ammonia,  urea,  creatinine,  creatine,lla  total  and  ethereal  sul- 
fates,  and  indican.11* 

The  analysis  of  the  feces  was  made  on  each  individual  stool.  As  passed 
it  was  weighed  and  thoroughly  mixed  until  uniform  throughout.  The 
samples  for  analysis  were  then  weighed  out  as  quickly  as  possible  to  pre- 
vent loss  by  evaporation,  which  is  very  rapid.  Charcoal  was  used  as  a 
"marker"  to  facilitate  the  separation  of  the  feces  of  different  periods; 
where  the  uniformity  of  the  diet  is  not  to  be  interfered  with  this  method 
is  the  most  satisfactory.  One  or  two  capsules  (0.2  gram)  of  finely  di- 
vided charcoal  were  taken  before  breakfast  on  the  day  beginning  a  new 
period.  With  but  few  exceptions  the  separations  thus  obtained  were 
very  distinct  and  entirely  satisfactory. 

The  length  of  time  between  the  taking  of  food  and  the  appearance  of 
the  feces  therefrom  has  been  variously  given.  A  recent  statement  is 
that  particles  fed  to  a  man  are  not  usually  passed  in  his  feces  for  two  or 
three  days.10  The  observations  of  the  present  experiments  support  the 
opinion  as  given  by  Strasburger13  that  normally  this  period  is  24  hours. 
Throughout  these  experiments  the  charcoal  given  on  one  morning  ap- 
peared in  the  last  portions  of  the  feces  passed  the  next  morning,  in  all 
but  two  cases,  in  both  of  which  the  separations  were  from  an  ordinary 
mixed  diet,  that  is,  at  the  beginning  or  at  the  end  of  the  experiment. 

Methods. — All  analyses  were  made  on  fresh  feces  without  previous 
drying,  and  were  always  made  in  duplicate  unless  the  amount  of  material 
available  was  not  sufficient.  The  analysis  of  the  fresh  stool12  to  our  mind 
is  the  ideal  method  of  feces  examination.  Certainly  in  view  of  Shimidzu's 
findings,  mentioned  below,  we  can  place  no  dependence  upon  data  ob- 
tained from  the  analysis  of  the  dried  sample. 13a  The  analysis  of  each  in- 
dividual stool  in  the  fresh  condition  of  course  demands  the  expenditure 
of  much  more  time  and  energy  than  are  necessitated  in  the  analysis  of 
composit  samples  of  dried  feces.  However,  the  added  accuracy  and  the 
greater  value  of  the  data  obtained  by  means  of  the  "fresh"  procedure 
certainly  warrant  the  extra  effort. 

The  method  selected  for  the  determination  of  fat  was  that  proposed 
and  developed  by  Kumagawa  and  Suto14  with  the  modifications  added 
by  Inaba.15  This  method,  above  all  others,  yields  a  product  that  can  be 
considered  to  be  more  nearly  pure  fat  than  that  yielded  by  any  other 
methods  of  extraction.1  The  method  as  described  by  its  authors  is  carried 
out  upon  air-dried  materials  but  for  our  determinations  no  air-drying 
was  employed.  Shimidzu150  has  shown  that  the  drying  of  tissues  on  the 

1  This  statement  does  not  apply  to  the  method  of  Folin  and  Wentworth  (/.  Biol. 
Chem.,  7,  421-6  (1910)),  with  which  we  have  had  no  experience.  It  appeared  after 
the  completion  of  this  work. 


STUDIES   ON  WATER   DRINKING.      VIII.  9 

water  bath  previous  to  the  determination  of  their  fat  content  by  this 
method  causes  a  loss  of  fat  which  may  exceed  10  per  cent.  The  loss  is 
probably  due  to  oxidation.  It  is  probable,  therefore,  that  in  the  deter- 
mination of  fat  in  feces  by  this  method,  the  use  of  fresh  material  without 
previous  drying  yields  most  accurate  results.  The  procedure  involves 
the  saponification  of  5-10  grams  of  fresh  feces  by  a  5  N  sodium  hydroxide 
solution  for  several  hours ;  this  is  overneutralized  with  20  per  cent,  hydro- 
chloric acid,  taking  care  to  keep  the  mixture  from  becoming  hot,  and  the 
acid  liquid  is  extracted  with  ether.  Any  precipitate  remaining  is  dis- 
solved in  hot  normal  sodium  hydroxide,  heated  for  about  15  minutes  and 
extracted  with  ether ;  the  acid  aqueous  solution  that  was  first  drained  off 
is  added  and  all  the  fat  and  fatty  acid  remaining  go  over  into  the  ether 
portion.  The  combined  ethers  are  evaporated,  the  residue  purified  by 
absolute  ether  and  lastly  by  petroleum  ether,  and  dried  at  60°  to  constant 
weight.  The  fatty  acids  so  obtained  were  crystallin  and  almost  color- 
less ;  care  in  preventing  overheating  during  the  first  neutralization  and  a 
sufficient  drying  of  the  last  ether  residue  before  taking  up  in  petroleum 
ether  are  essential  to  obtaining  them  in  pure  form. 

It  is  evident  that  by  this  method  the  unsaponifiable  substances  are  deter- 
mined along  with  the  fatty  acid  and  the  authors14  give  a  satisfactory 
procedure  by  which  these  may  be  determined.  It  was  shown  by  Inaba15 
that  the  unsaponifiable  substances  in  the  feces  amount  to  about  10  per 
cent,  of  the  total  fatty  acids  determined  and  that  a  separation  of  these 
substances  is  of  importance,  if  most  accurate  results  are  desired.  In- 
asmuch as  a  uniform  diet  was  fed  in  these  experiments,  any  difference 
in  the  fat  content  of  the  feces  from  one  period  to  another  was  probably 
subject  to  no  correction  on  this  account. 

Experiments  on  Copious  Water  Drinking  with  Meals. 

General  Description. — The  first  experiments  on  Subjects  H  and  W 
may  now  be  considered  in  detail.  Subject  H  was  a  tall  well-proportioned 
man  weighing  70.22  kilograms  at  the  beginning  of  the  experiment.  He 
had  been  on  a  diet  of  comparatively  simple  variety  and  as  he  was  not 
fond  of  milk  and  drank  neither  tea  nor  coffee,  water  comprized  the  chief 
liquid  portion  of  his  diet.  Subject  W  was  of  smaller  stature  and  weighed 
63.2  kilograms  at  the  beginning  of  the  experiment.  He  was  accustomed 
to  the  diet  as  offered  by  a  club  table  of  the  better  grade  and  usually 
drank  water  sparingly.  He  regularly  smoked  a  cigar  after  the  evening 
meal  and  did  so  throughout  the  experiment.  Both  subjects  were  put 
upon  the  same  uniform  diet  of  graham  crackers,  butter,  peanut  butter 
and  milk.  It  contained  180  grams  of  fat  per  day  distributed  for  each 
food  and  meal  as  follows : 


10  STUDIES  ON  WATER  DRINKING.      VIII. 

Amount.  Pat. 

Oatmeal  crackers 150  grams  it .  7  grams 

Peanut  butter 20  9.2 

Butter 25  21.  i 

Milk 450  (cc.)  18  .o 

Water 100  cc.  

Total,  60.0 

In  addition,  200  cc.  of  water  were  taken  at  10  A.M.,  at  3  P.M.,  and  again 
in  the  evening  or  just  before  retiring,  making  a  total  of  900  cc.  of  water 
per  day  during  the  three-day  preliminary  period.1  On  the  morning 
of  the  fourth  day  before  breakfast  charcoal  was  taken  and  during  the  five 
days  following  one  liter  of  water  was  added  to  the  menu  of  each  meal, 
making  noo  cc.  per  meal  and  a  total  of  3900  cc.  per  day.  On  this  diet 
both  subjects  record  a  feeling  of  fulness  that  sometimes  became  tem- 
porarily slightly  uncomfortable.  It  was  necessary  to  urinate  frequently 
especially  during  the  first  few  hours  after  the  meal ;  for  a  short  time  after 
eating  there  was  a  desire  to  remain  quiet  and  inactive,  as  is  the  case  after 
any  full  meal ;  within  three-quarters  of  an  hour  or  an  hour,  approximately 
half  the  water  taken  at  the  meal  was  voided.  Both  subjects  record  that 
the  feeling  of  fulness  and  lassitude  noted  immediately  after  meals  became 
less  marked  after  the  second  day  of  the  water  period.  Both  felt  per- 
fectly well  at  all  times  and  had  normal  appetites.  After  the  fourth  day 
H  records  that  he  did  not  notice  the  feeling  of  fulness  which  followed  the 
high  water  ingestion  of  the  first  few  days  of  the  water  period. 

The  period  of  copious  water  ingestion  lasted  five  days.  On  the  morning 
of  the  sixth  day  charcoal  capsules  were  taken  before  breakfast  and  during 
that  and  the  two  following,  days  the  diet  of  the  preliminary  period  was 
resumed.  The  experiment  ended  with  the  taking  of  charcoal  on  the 
morning  of  the  fourth  day  of  this  period. 

Discussion  of  Results. — The  data  upon  the  excretion  of  fat  in  the  feces 
during  these  three  periods  are  given  in  Tables  I  and  II. 

Subject  H,  Table  I. — The  data  show  that  the  average  daily  excretion 
of  fat  during  the  preliminary  period  was  8.37  grams,  during  the  water 
period  7.16  grams  and  9.22  grams  during  the  final  period.  The  digestion 
and  absorption  of  fat  were  seemingly  more  complete  during  the  water 
period  than  during  the  preliminary  period  and  upon  the  withdrawal 
of  water  the  excretion  of  fat  rose  to  an  amount  that  was  higher  than  be- 
fore the  period  of  water  ingestion.  A  slight  gain  in  weight  was  recorded, 

1  The  water  supply  (see  Fowler  and  Hawk,  /.  Exp.  Med.,  12,  390  (1910))  of  this 
community  is  from  deep  wells  and  for  use  in  these  experiments  it  was  softened  by  the 
addition  of  five  liters  of  saturated  lime  water  to  thirty  liters  of  the  tap  water.  After 
standing  several  hours  or  a  day  the  precipitate  was  filtered  off.  This  water  had  an 
agreeable  taste;  its  alkalinity  was  70  to  phenolphthalein,  180  to  methyl  orange,  and  its 
hardness  determined  by  soap  solution  was  92  parts  per  million. 


STUDIES  ON  WATER  DRINKING.      VIII. 


II 


70.29  kilograms  on  the  morning  of  the  first  day  of  water  and  70.88  kilo- 
grams on  the  morning  of  the  first  day  after  the  water.  This  gain  of  600 
grams  was  not  lost  for  at  least  three  months  thereafter. 

TABLE  I. — SUBJECT  H. 

Water  period.    5  days.  Final  period.    3  day*. 


Preliminary  period.    3  days. 

Number 
of  stool.1 


Number 
of  Stool.1 


Total 

Average.  . . 


Fat. 

2.16 
5.65 
3.58 

16.59 
7-80 

35-78 
7.16 


Number 
of  stool. i 


Fat. 
6.06 


TABLE  II. — SUBJECT  W. 

Water  period.    5  days. 


IO 

ii T   ~2 . 14 

12 8.79 

13 10.68 

Total 27.67 

Average.  ...       9.22 


Final  period.    3  days. 


Number 
of  stool. 

Fat. 
*  80 

6 

i  31 

7 

5.98 

g 

6   4.1 

7  .OI 

IO       .... 

2    64. 

Total.  .  .  . 
Average. 

...       29.15 
...         5.83 

Number 
of  stool. 

II       .     .         .     . 

Fat. 

Sc6 

12 

7    76 

J-3  .  . 

1.84 

14. 

6    14. 

Total 

21     SO 

Average.  .  .  . 

7.17 

Fat. 

3.23 

5.16 

9-73 

7-00 

Total 25.12 

Average ....  8.37 


Preliminary  period.    3  days. 

Number 

of  stool.  Fat. 

1 9.22 

2 10. 60 

3 3.85 

4 7-QQ 

Total 30.67 

Average.  ...  10.22 


Subject  W,  Table  II. — During  the  preliminary  period  there  was  an 
average  daily  excretion  of  10.22  grams  of  fat  in  the  feces.  During  the 
water  period  this  was  reduced  to  an  average  of  5.83  grams  per  day  and 
in  the  final  period  it  rose  to  7.17  grams  per  day,  an  amount  only  slightly 
above  that  of  the  water  period.  From  these  data  it  would  appear  that 
during  the  period  of  copious  water  drinking  the  fats  of  the  food  were  more 
completely  digested  and  absorbed  than  either  before  or  after  this  period 
and  that  this  effect  of  the  water  drinking  was  not  temporary  but  more 
or  less  permanent.  In  the  case  of  W  also  a  slight  gain  in  weight  accom- 
panied the  experiment.  On  the  morning  of  the  first  day  of  water  his 
weight  was  63.46  kilograms;  at  the  end  of  this  period  it  was  64.16  kilo- 
grams. This  gain  of  700  grams  might  be  attributed  to  retained  water, 
except  for  the  fact  that  it  was  not  lost  subsequently.  After  the  lapse 
of  three  months,  during  which  time  the  subject  was  on  an  ordinary  mixed 
diet,  his  weight  was  identically  the  same  as  at  the  end  of  the  water  period 
of  this  experiment.  While  great  significance  can  not  be  attached  to  so 
small  a  change  in  weight,  even  granted  that  it  is  not  due  to  water,  it  must 
nevertheless  be  borne  in  mind  that  the  diet  throughout  the  experiment 
was  absolutely  uniform  with  the  exception  of  the  water  ingestion. 
1  Weights  of  all  stools  are  included  in  the  third  paper  of  the  series. 


12  STUDIES  ON  WATER  DRINKING.      VIII. 

It  seemed  reasonable  to  assume  that  the  decreased  excretion  of  fat 
during  the  water  period  was  due  to  more  complete  utilization  as  a  result 
of  the  large  volumes  of  water  ingested,  and  several  explanations  could 
be  suggested.  Of  first  importance  was  the  direct  stimulating  effect  of 
water  upon  the  digestive  juices.  In  his  first  experiments  on  dogs  Pavlov3 
found  that  a  large  amount  of  water  (500  cc.)  caused  a  flow  of  gastric 
juice,  while  a  small  amount  (150  cc.)  in  half  the  cases  observed  had  not 
the  least  effect.  He  states  that  the  important  factor  is  a  prolonged  and 
widely  spread  contact  of  water  with  the  gastric  mucous  membrane. 
This  contact  can  hardly  be  called  prolonged  because  of  the  rapid  passage 
of  water  through  the  pylorus;  this  very  circumstance,  however,  might 
make  a  large  volume  of  water  effective  as  against  a  small  volume  in  that 
the  former  did  secure  a  more  widely  spread  contact  than  the  latter,  and 
perhaps  also  for  a  slightly  longer  period  of  time.  To  obtain  further 
information  on  this  point  it  was  considered  worth  while  to  make  another 
experiment  upon  the  effect  of  a  smaller  amount  of  water  taken  with  meals, 
but  whose  use  should  extend  over  a  longer  period  of  time. 

Experiments  on  Moderate  Water  Drinking  with  Meals. 

Description,  Methods,  Etc. — The  plan  of  the  experiment  was  exactly 
the  same  as  that  of  the  previous  one.  Two  subjects  were  maintained  on  a 
uniform  diet  of  small  water  content  for  several  days.  Then  during  a 
period  of  ten  days  in  which  the  same  diet  was  continued,  500  cc.  of  water 
in  addition  to  the  usual  amount  were  taken  with  each  meal.  In  the 
final  period  the  conditions  of  the  preliminary  period  were  again  in  force. 
The  daily  routine  was  the  same  as  in  the  preceding  experiment.  Char- 
coal was  used  to  separate  the  feces  of  the  different  periods  and  the  analyses 
were  made  on  each  individual  stool  in  a  fresh  condition. 

After  an  interval  of  about  three  months  W,  of  the  preceding  experi- 
ment, again  served  as  subject.  In  the  meantime  he  had  been  at  the  same 
table  as  before,  had  had  much  the  same  kind  of  food,  and  in  general  the 
same  dietary  habits  with  the  exception  that  he  had  formed  the  habit 
of  taking  more  water  with  his  meals  than  before  the  first  experiment. 
His  weight  at  the  beginning  of  this  experiment  was  64.18  kilograms, 
almost  exactly  the  same  as  at  the  end  of  the  first  experiment. 

Subject  E  was  of  the  average  build  and  weighed  73.6  kilograms.  His 
habits  of  eating  were  irregular.  During  the  previous  year  he  had  for  a 
time  lived  on  one  substantial  lunch-counter  meal  a  day,1  later  on  two, 
and  during  the  months  preceding  the  experiment  on  three  at  a  regular 
table.  He  was  accustomed,  ordinarily,  to  taking  considerable  amounts 
of  water  with  his  meals. 

The  food  of  each  meal,  and  its  fat  content  were  as  shown : 

1  Howe,  Mattill  and  Hawk,  /.  Am.  Chem.  Soc.,  33,  570  (1911). 


STUDIES   ON   WATER  DRINKING.      VIII.  13 

(In  grams.)  Amount.  Fat. 

Oatmeal  crackers 150  12 .9 

Peanut  butter 20  9.2 

Butter 25  21.  i 

Milk 400  (cc.)  16.0 

Water 100  cc. 

Total,  59.2 

The  diet  of  W  was  slightly  reduced  from  what  it  had  been  before  and 
was  as  follows : 

(In  grams.)                                     Amount.  Fat. 

Oatmeal  crackers 125  10.8 

Peanut  butter 20  9.2 

Butter 25  21 .  i 

Milk 400  (cc.)  16.0 

Water 100  cc. 

Total,  57.1 

In  addition,  each  man  took  200  cc.  of  water  at  10  A.M.,  at  3  and  at 
8.30  P.M.,  making  a  total  water  ingestion  of  900  cc.  per  day  during  the 
preliminary  period.  During  the  water  period  the  addition  of  500  cc.  of 
water  to  each  meal  made  the  total  water  ingestion  2400  cc.  per  day  during 
that  time. 

Discussion  of  Results.  Subject  W. — On  the  diet  as  given,  some  little 
difficulty  was  experienced  in  obtaining  nitrogen  equilibrium  in  the  pre- 
liminary period.  Charcoal  was  taken  on  the  morning  of  the  eighth  day, 
but  for  the  sake  of  keeping  uniformity  in  the  feces  data  it  seemed  best 
not  to  change  the  diet.  Six  days  passed  and  on  the  morning  of  the 
fourteenth  day  charcoal  was  again  taken  and  water  added  to  the  regular 
diet.  The  separation  of  the  preliminary  period  into  two  parts  proved 
to  be  a  very  important  incident  in  view  of  what  the  feces  data  show 
(Table  III). 

TABLE  III. — SUBJECT  W. 


I. 

Preliminary 
period.    7  days. 

ii. 

Preliminary 
period.    6  days. 

Water 
period.    10  days. 

Final 
period.    5  days. 

Number                                 Number                                 Number 
of  stool.                       Fat.      of  stool.                     Fat.      of  stool. 

I.                                12    ^O            i                             *    """*             T/l 

i 
F«t.    o 

1.84 
IO.I8 
4.70 
9.70 
3-89 
7-54 
1-74 
11-59 
7-85 
8.72 

lumber 
f  stool.                    Fat. 

24  3-54 

oe                              6    "\8 

2  3.19 
1.  .                              42^ 

87   47 

T  e 

Q    .                       8   O7 

*D  

16 

26.  .                  •*.  **6 

44   71 

10                  10  52 

17 

27  ..                       8    ^6 

5               ...    12  20 

II                             321 

18 

28                              *    S4 

6  5.06 

12  5-97 

IQ.  . 

29  4.08 

Total  41-69 
Average  .  .     5  .  96 

I-l.  .                               I     QO 

2O 

Total  ...  31.66 
Average.     6.33 

Total  41.24 
Average  .     6  .  89 

21  

22     .... 

23 

Total.  .  .  . 
Average. 

67.75 
6.78 

14  STUDIES  ON  WATER  DRINKING.      VIII. 

During  the  time  that  intervened  between  his  two  experiments  Subject 
W,  as  has  been  mentioned,  while  on  an  ordinary  mixed  diet,  continued 
the  habit  of  taking  considerable  water  with  his  meals.  As  is  evident 
from  the  diet  of  the  preliminary  period  the  amount  of  water  taken  was 
small  and  was,  in  fact,  much  less  than  he  was  accustomed  to  use.  While 
this  restricted  amount  of  water  did  not  immediately  make  itself  felt  in 
the  first  few  days  of  the  experiment,  it  did  begin  to  show  in  the  latter  part 
of  the  preliminary  period  by  a  seemingly  less  complete  digestion  and 
absorption  of  fat.  This  is  evident  in  an  increase  in  the  average  daily  fecal 
output  of  fat  during  the  second  part  of  the  preliminary  period.  The 
average  daily  amount  of  fat  excreted  in  the  first  part  of  this  period  was 
5.96  grams  as  against  6.89  grams  in  the  second  part.  Since  the  charcoal 
separation  of  this  preliminary  period  into  two  portions  was  clear  and 
definit  this  increase  in  fat  in  the  feces  during  the  latter  part  seems  to 
mean  a  less  efficient  digestion  and  utilization  of  the  fat  of  the  food.  That 
this  evidence  did  not  appear  until  some  days  after  the  amount  of  water 
had  been  reduced  indicates,  as  hi  the  first  experiment,  that  the  beneficial 
effect  which  water  had  upon  digestion  and  absorption  did  not  cease  with 
the  withdrawal  of  water,  but  was  more  or  less  permanent  beyond  the 
time  during  which  water  was  taken  with  the  meals.  The  evidence  given 
by  this  finding  was  entirely  unlocked  for  and  seems  to  be  of  great  im- 
portance. 

Attention  should  also  be  called  to  the  comparison  of  the  fat  data  of 
this  preliminary  period  with  those  of  the  preliminary  period  of  the  first 
experiment,  Table  II.  The  average  daily  amount  of  fat  excreted  in  the 
preliminary  period  of  the  first  experiment  was  10.22  grams  as  against 
5.96  in  the  second.  The  average  percentage  utilization  of  fat  in  the 
former  was  94.3  per  cent,  as  against  96.5  per  cent,  hi  the  latter.  These 
data  showing  so  pronounced  an  improvement  hi  the  digestion  and  utiliza- 
tion of  fat  are  on  an  individual  living  on  the  same  kind  of  food,  but  sepa- 
rated by  a  period  of  three  months  in  which  water  drinking  with  meals 
was  practiced.  From  these  results  the  conclusion  as  to  the  effect  of  water 
drinking  with  meals  upon  the  utilization  of  fat  is  further  strengthened. 

It  is  further  seen  in  Table  III  that  the  average  daily  excretion  of  fat 
in  the  preliminary  period,  6.89  grams,  suffered  but  little  change  in  the 
water  period,  6.78  grams,  but  was  slightly  decreased,  6.33  grams,  in  the 
final  period.  Just  why  this  decrease  should  have  come  in  the  final  period 
rather  than  during  the  water  period  is  not  clear.  Perhaps  there  is  a  lag 
in  the  appearance  of  the  results  of  water  drinking,  just  as  it  has  been 
shown  that  its  effects  are  more  or  less  permanent.  In  this  case  the 
moderate  amount  of  water  may  have  had  a  stimulatory  effect  that  was 
not  evident  during  the  water  period  but  made  itself  felt  during  the  period 
following.  The  question  of  individuality  probably  enters  in  also.  From 


STUDIES   ON   WATER  DRINKING.      VIII.  15 

a  study  of  the  data  on  Subject  W  during  this  experiment  it  may  be  con- 
cluded that  the  effect  of  moderate  water  drinking  with  meals  upon  diges- 
tion is  in  the  same  direction  as  that  of  copious  water  drinking  but  some- 
what less  marked. 

Subject  E. — An  examination  of  Table  IV  shows  the  variations  in  fat 
excretion  from  one  period  to  another  to  be  small  although  similar  to  those 
obtained  before.  The  output  of  fat  fell  from  6.6 1  grams  per  day  in  the 
preliminary  period  to  6.39  grams  per  day  under  the  influence  of  moderate 
water  drinking,  and  again  rose  to  6.70  in  the  final  period. 

Again  it  appears  that  the  effect  of  drinking  water  in  moderate  amounts 
with  meals  is  in  the  same  direction  as  when  large  amounts  are  used,  al- 
though the  differences  observed  are  of  a  smaller  order  of  magnitude;  as 
with  the  copious  amounts,  absolutely  no  harmful  effects  were  to  be  ob- 
served. With  moderate  amounts  of  water  the  inconvenience  of  dis- 
posing of  an  unusual  quantity  of  liquid  after  the  meal  was  removed,  and 
the  lethargic  effects  of  a  full  meal,  such  as  were  noted  under  the  experi- 
ment on  copious  water  drinking,  were  also  avoided. 

TABLE  IV. — SUBJECT  E. 

Preliminary  period.    7  days.  Water  period.     10  days.  Final  period.    4  days. 


Number 

Number 

Number 

of  stool. 

Fat. 

of  stool. 

Fat.     of  stool. 

Fat. 

I  

3-79 

9  

3-33        20  

..       2.79 

2  

i.5i 

10  

••        5.85        21  

..       5-60 

3  

8.96 

II  

3.96         22  

••       7-75 

4  

11.63 

12  

8.20      23  

..       7.88 

5  

3-92 

13  

9-78         24  

..       2.77 

f. 

8f.fi 



7  

5-20 

15  

7.07          Total  

..     26.79 

8  

2.63 

16  

3-63          Average 

6.70 

Total  

46.30 

•7  
18  

2  .  90 

••       9-59 

Average  

6.61 

19  

..       3-io 

Total  

.-     63.91 

Average  

6.39 

The  results  just  given  were  obtained  on  subjects  one  of  whom  (W) 
had  lately  become  accustomed  to  drinking  with  meals ;  the  other  of  whom 
(E)  habitually  took  considerable  water  with  his  meals.  In  each  case  the 
organism,  though  accustomed  to  the  presence  of  water  in  the  alimentary 
tract  during  digestion,  responded  to  an  increase  in  its  amount  by  a  better 
utilization  of  the  fat  of  the  food.  The  results  obtained,  therefore,  prob- 
ably represent  the  minimum  rather  than  the  maximum  effect  that  may  be 
obtained  by  moderate  water  drinking  with  meals,  and  are  such  as  might 
safely  be  expected  in  any  individual,  but  especially  in  one  not  accustomed 
to  drinking  water  under  these  conditions. 


1 6  STUDIES  ON  WATER  DRINKING.      VIII. 

The  Effect  of  Copious  Water  Drinking  with  Meals  upon  an  Habitual 

Water  Drinker. 

At  this  point  an  answer  was  sought  to  the  question  as  to  whether  a 
very  large  water  ingestion  with  meals  would  show  its  effect  upon  digestion 
even  though  relatively  large  amounts  of  water  were  habitually  taken  at 
meal  time.  For  this  investigation  Subject  E  seemed  very  well  fitted; 
during  the  experiment  on  moderate  water  drinking  he  had  frequently 
made  it  his  boast  that  he  was  not  drinking  more  water  with  his  meals 
during  the  water  period  than  was  his  custom.  It  seemed  advizable 
therefore  to  try  upon  E  the  effect  of  such  amounts  of  water  as  would  be 
copious  for  his  digestive  mechanism. 

Description. — Continuing  with  the  same  diet  as  in  the  final  period  of  the 
previous  experiment,  a  period  of  six  days  was  made  the  preliminary 
period  for  this  experiment.  During  the  five  days  following  this  period 
an  addition  of  one  and  one-third  liters  of  water  was  made  to  the  water 
ingestion  of  each  meal.  This  is  a  larger  amount  of  water  than  was  used 
in  the  first  experiment  on  copious  water  drinking,  where  only  1000  cc. 
additional  were  taken  with  each  meal.  A  final  period  of  three  days 
closed  the  experiment.  On  the  very  first  day  of  this  large  water  inges- 
tion Subject  E  records  that  he  had  no  trouble  in  drinking  all  of  the  water, 
nor  was  any  discomfort  experienced  throughout  the  experiment. 

TABLE  V. — SUBJECT  E. 

Preliminary  period.    6  days.  Water  period.    5  days.  Final  period.    3  days. 


Number 
of  stool. 

I                       .    . 

Number 
Pat.      of  stool. 

...         2.75          8           

Number 
Fat.     of  stool. 

•7    17         14. 

Fat. 
*  c8 

2 

4.   28 

I    84.         11 

i  87 

10  87 

IO 

ii   i^       16 

O'°i 

8  69 

A 

C     QO 

II        

44.6         17 

o  82 

7    4/1 

12       

7-33 
3  53          Total 

18  96 

6 

8    5Q 

1  1 

7 

I  .07 

Total  
Average  

Average.  .  . 
31-68 

6.34 

.        6.24 

Total    

41  .80 

Averaee.  . 

6.Q7 

Discussion  of  Results. — Table  V  shows  that  the  average  daily  excretion 
of  fat  in  the  preliminary  period,  6.97  grams,  fell  to  6.34  grams  in  the  water 
period,  and  the  daily  average  value  for  the  final  period,  6.24  grams,  was 
even  slightly  less  than  for  the  water  period.  The  effect  of  copious  water 
drinking  with  meals  is  seen  to  be  in  the  same  direction  when  the  organism 
is  accustomed  to  water  drinking  as  when  it  is  not,  except  that  when  water 
drinking  with  meals  is  habitual  the  results  are  less  striking  than  otherwise. 
Inferences  and  Discussion. 

All  of  the  observations  made  have  pointed  to  a  decreased  elimination 
of  fat  in  the  feces  when  water  was  taken  with  meals,  indicating  a  more 


STUDIES  ON   WATER   DRINKING.      VIII.  17 

complete  utilization  of  the  fat  of  the  food  than  without  the  water  in- 
gestion,  and  in  most  instances  the  evident  better  digestion  continued  for 
several  days  beyond  the  period  during  which  an  increased  water  in- 
gestion  was  practiced.  A  large  amount  of  water  was  more  efficient  in 
this  regard  than  a  small  one  and  a  more  pronounced  result  was  obtained 
in  persons  not  used  to  water  drinking  with  meals  than  in  those  for  whom 
it  was  habitual. 

The  results  of  our  experiments  warrant  more  than  a  negative  con- 
clusion. The  ingestion  of  water  along  with  the  food  secures  a  better 
utilization  of  the  fat  of  the  food  as  shown  by  a  diminished  excretion  of 
fat  in  the  feces.  It  is  possible  to  explain  this  result  on  the  basis  of  four 
different  facts. 

(i)    The  Stimulating  Action  of  Water  upon  the  Gastric  Secretion  and  In- 
dependently upon  the  Secretion  of  Pancreatic  Juice  and  Bile. 

The  facts  observed  by  Pavlov  and  his  co-workers3  mentioned  above, 
and  the  findings  of  Foster  and  Lambert4  as  to  the  stimulating  action  of 
water  upon  the  gastric  secretion  in  dogs  have  also  been  observed  in  human 
beings  with  gastric  and  esophageal  fistulas.  In  some  of  the  older  in- 
vestigations it  was  shown16'  17'  18  that  a  purely  psychic  secretion,  such  as 
is  noted  in  dogs,  is  not  as  pronounced  in  man  as  in  these  animals.  A 
pleasant  taste  of  food  in  the  mouth  caused  a  flow  of  gastric  juice  in  some 
instances,  but  whether,  in  general,  such  a  secretion  of  gastric  juice  in  man 
arizes  indirectly  through  stimulation  carried  by  the  blood  or  by  the 
nerves,  or  whether  it  is  due  directly  to  the  contact  of  substances  with  the 
mucous  membrane  of  the  stomach  is  uncertain.  The  observations  of 
Bogen,19  Kaznelson,20  and  Sommerfeld21  upon  patients  with  gastric 
fistulas  have  clearly  demonstrated  a  psychic  secretion.  Most  varied 
stimuli  through  taste,  smell,  and  sight  of  food,  and  through  sounds  asso- 
ciated with  the  preparation  of  food  called  forth  a  secretion  of  gastric 
juice.  In  the  subject  examined  by  Lavenson22  no  psychic  secretion  was 
demonstrable  but  water  was  found  to  be  a  definit  though  not  powerful 
stimulus.  Sommerfeld21  was  able  to  show  that  water  had  a  stimulating 
action  upon  the  gastric  secretion,  and  further,  that  the  mere  drinking  of 
water,  after  the  manner  of  sham  feeding,  caused  a  flow  of  gastric  juice. 
It  is  claimed  that  saliva  is  not  a  factor  in  inducing  gastric  secretion. 
The  evidence  adduced  by  Hemmeter23  as  to  a  salivary  hormone  producing 
increased  flow  of  gastric  juice  could  not  be  verified  by  Loevenhart  and 
Hooker.24  The  stimulating  factor  may  be  mastication  itself,  including 
the  taste  phenomena  and  also  the  desirability  of  the  food. 

In  human  beings  as  well  as  in  the  lower  animals  investigated  the  acidity 
of  the  gastric  juice  is  found  to  vary  with  the  kind  of  food.  The  findings 
of  Foster  and  Lambert4  on  dogs  with  accessory  stomach  indicate  not  only 


18 


STUDIES  ON   WATER  DRINKING.      VIII. 


a  more  voluminous  but  also  a  more  acid  secretion  when  water  is  taken 
with  food  and  they  suggest  an  automatic  control  in  the  stomach,  such 
that  the  chyme,  no  matter  what  its  state  of  dilution,  always  has  the  same 
optimum  acid  concentration.  The  increased  acidity  noted  in  the  acces- 
sory pouch  may  not  actually  exist  in  the  stomach  proper;  here,  by  dilu- 
tion, the  acid  concentration  may  remain  unchanged.  Certain  other 
experiments  reported  from  this  laboratory24*1  apparently  confirm  this 
view.  If  the  stimulation  of  water  is  entirely  a  chemical  one,  however, 
it  is  difficult  to  see  why  the  mucosa  of  the  pouch,  which  is  not  in  contact 
with  the  water,  should  respond  as  readily  as  the  stomach  itself,  even 
though  it  has  the  same  nerve  and  blood  supply.  Any  effect  which  the 
accessory  pouch  shows  may  possibly  be  less  marked  than  the  one  actually 
secured  in  the  stomach  proper. 

Whether  an  increased  acidity  and  digestive  power  of  the  gastric  juice 
is  of  immediate  importance  in  the  digestion  of  fat  is  not  clear.  The 
cleavage  of  fat  by  gastric  lipase  is  very  minimal  in  the  normal  acid  re- 
action of  the  stomach  except  when  the  fats  are  in  the  form  of  a  natural 
emulsion.  London  and  Versilova25  showed  that  in  dogs  the  cleavage 
of  fat  fed  in  such  a  form  (egg-yolk)  rose  as  high  as  32  per  cent,  in  the 
stomach,  due  in  part  to  gastric  lipase  and  in  part  to  regurgitated  duodenal 
juice.  A  similar  observation  has  been  made  recently  by  Levites.28 
Kaznelson20  found  a  lipase  in  the  gastric  juice  of  her  patient.  According 
to  Lavenson's  observations22  a  regurgitation  of  bile  and  pancreatic  juice 
in  the  stomach  occurred  with  great  constancy  when  oil  was  given. 

No  absorption  of  fat  takes  place  in  the  stomach.  In  the  experiments 
of  London  and  Versilova25  where  one-third  of  the  fat  administered  was 
split  in  the  stomach  no  absorption  took  place  until  this  material  reached 
the  ileum.  As  a  result  of  their  findings  Camus  and  Nicloux27  and  also 
Stire28  emphasize  the  unimportance  of  gastric  lipase.  The  fats  undergo 
practically  no  change  in  the  stomach,  and  when  they  do  it  is  as  a  result 
of  a  regurgitated  duodenal  secretion. 

In  view  of  these  facts  the  importance,  for  fat  digestion,  of  the  greater 
quantity  of  gastric  juice,  or  a  greater  acidity,  or  both,  as  a  result  of  the 
stimulating  action  of  water  with  the  food  is  to  be  sought  rather  in  the 
effect  upon  the  secretion  of  the  bile  and  the  pancreatic  juice. 

(2)    The  Acid  Chyme  as  an  Excitant  for  the  Flow  of  Pancreatic  Juice 

and  Bile. 

The  formation  of  secretin  from  prosecretin  is  the  result  of  an  acid 
reaction  of  the  duodenum;  the  larger  the  amount  of  acid  the  greater  the 
stimulation  given  to  the  secretory  action  of  the  pancreas,  and  the  flow 
of  bile  is  regulated  by  the  same  mechanism.  That  the  efficiency  of  bile 
in  aiding  the  digestioa  of  fats  by  pancreatic  lipase  is  due  to  the  bile  acids 


STUDIES   ON   WATER   DRINKING.      VIII.  19 

has  again  been  shown  recently  by  Terroine.29  The  same  investigator 
has  also  shown30  that  at  an  optimum  concentration  of  pancreatic  juice 
and  of  esters  or  whatever  other  substances  are  undergoing  cleavage,  the 
hydrolysis  is  activated  proportionately  by  increasing  quantities  of  bile 
salts. 

Fat  in  small  amounts  is  a  regular  constituent  of  pancreatic  juice  and 
especially  of  the  bile,  and  an  increase  in  these  secretions  should  cause 
increased  elimination  of  fat  in  the  feces  unless  a  compensation  was  found. 
This  increased  excretion  is  not  found,  but,  on  the  contrary,  a  constant 
decrease  is  observed  under  the  influence  of  water  drinking  with  meals. 
It  follows  from  this  that  the  digestibility  of  fat  during  the  period  of  water 
drinking  with  meals  was  increased  even  beyond  what  the  data  indicate, 
since  part  of  the  excreted  fat  might  come  from  the  larger  amounts  of 
digestive  juices  secreted  under  the  stimulating  influence  of  water.  And 
furthermore  inasmuch  as  the  fat  values  for  the  stools  derived  by  the 
Kumagawa-Suto  technic  include  any  cholesterol  present,  the  increased 
output  of  biliary  cholesterol  during  the  water  period  would  also  be  a 
factor  tending  toward  an  apparently  augmented  output  of  fecal  fat  dur- 
ing this  interval. 

(3)  Heightened  Peristalsis  and  Increased  Blood  Pressure  as  Factors  in 
the  More  Complete  Digestion  and  Utilization  of  Fat. 

Peristalsis  is  known  to  increase  with  the  volume  of  material  within  the 
intestin.  Whether  a  large  amount  of  a  liquid  mass  is  as  efficient  in  this 
regard  as  an  equal  bulk  containing  less  water  is  uncertain.  The  effect 
of  dilution  and  increased  peristalsis  brought  on  by  purgatives  was  shown 
by  Ury31  not  to  increase  the  amount  of  soluble  foodstuffs  or  of  their 
products  in  the  feces.  His  observations  were  limited  to  soluble  protein 
and  to  sugar. 

Water  begins  to  pass  the  pylorus  very  soon  after  its  ingestion,  and  is 
quickly  absorbed.  During  the  time  that  this  water  is  in  the  tissues  and  is 
flowing  in  the  blood  stream,  the  increased  volume  causes  a  rise  in  blood 
pressure  similar  to  the  rise  regularly  following  a  meal.  In  duplicate 
feeding  experiments  on  a  dog  with  gastric  fistula  Dobrovolskii32  found 
that  after  bleeding  there  was  an  almost  complete  stoppage  of  the  process 
of  digestion  during  the  first  3  hours,  due  in  part  to  the  decreased  blood 
pressure.  No  measurements  of  blood  pressure  were  made  during  these 
experiments  on  water  drinking;  it  seems  reasonable  to  assume,  however, 
that  a  greater  blood  pressure  and  a  consequent  stronger  and  more  rapid 
heart  beat  might  also  be  factors  in  the  more  complete  absorption  of  the 
fat  of  the  food  when  water  is  taken  with  meals. 

Both  of  these  factors,  peristalsis  and  blood  pressure,  are  to  be  investi- 
gated as  to  the  effect  which  large  volumes  of  water  with  meals  have  upon 
them. 


2O  STUDIES  ON  WATER  DRINKING.      VIII. 

(4)  Dilution  as  a  Factor  in  More  Complete  Utilization. 

More  important  than  any  of  the  other  factors,  probably,  is  this  one  of 
dilution.  Like  all  other  chemical  reactions,  those  brought  about  by 
enzymes  are  reversible.  Governing  these  is  the  general  principle  ex- 
pressed in  LeChatelier's  theorem  which  states  that  when  a  system  in 
equilibrium  is  subjected  to  a  constraint  by  which  the  equilibrium  is 
shifted,  a  reaction  takes  place  within  the  system  which  opposes  the  con- 
straint, i.  e.,  one  by  which  its  effect  tends  to  be  destroyed.  Processes 
within  the  system  tend  to  counteract  the  effect  of  external  changes. 
Thus  the  dilution  of  any  solution  in  which  the  reaction  AB  ~^~*'  A  -f  B 
had  come  to  equilibrium  would  result  in  the  formation  of  further  amounts 
of  A  and  B  in  order  to  increase  the  total  concentration  of  dissolved  ma- 
terial by  way  of  counteracting  the  effect  of  dilution.  The  reaction  would 
be  driven  toward  the  right  and  would  be  brought  more  nearly  to  com- 
pletion. Looked  at  in  another  way  such  a  reversible  reaction  as  given 
above  reaches  an  equilibrium  whose  constant  is  expressed  by  the  equa- 
tion Ca  X  Cb/Cab  =  K.  The  numerical  value  of  this  fraction  as  expressed 
by  K  remains  unchanged  whatever  the  total  concentration  of  the  solu- 
tion may  be.  If  the  solution  is  diluted,  causing  a  reduction  in  all  three 
of  the  terms  Ca,  Cb  and  C^,  the  values  Ca  and  Cb  must  diminish  relatively 
less  rapidly  than  Cab  in  order  that  K  should  remain  the  same.  And  in 
order  to  accomplish  this  some  of  the  substance  whose  concentration  is 
C^  is  transformed  into  the  substances  whose  concentrations  are  Ca  and 
Cb.  A  concentrating  of  the  solution  would  have  the  opposit  effect. 
Now  all  of  the  hydrolytic  cleavages  occurring  in  digestion  are  of  the  type 
AB  <  >  A  +  B,  i.  e.,  a  single  substance  is  broken  up  into  two  or  more 
products,  and  such  reactions  are  brought  the  more  nearly  to  completion 
the  greater  the  dilution  in  which  they  take  place.  The  corresponding 
synthetic  reactions  are  accomplished  by  beginning  with  a  high  con- 
centration of  the  corresponding  decomposition  products. 

The  failure  to  provide  for  the  removal  of  the  end-products,  either  by 
dilution  or  by  dialysis,  has  often  been  shown  to  prevent  a  reaction  from 
going  to  completion.  In  experiments  upon  the  saponification  of  fats  by 
pancreatic  juice  obtained  by  fistula  from  a  dog  Terroine  showed33  that 
the  addition  of  oleic  acid  or  of  sodium  oleate  to  olein  emulsions  rendered 
saponification  of  the  latter  more  difficult.  The  addition  of  glycerol  to 
suspensions  of  olive,  castor,  and  cottonseed  oils  had  the  contrary  effect 
of  making  them  much  more  readily  saponifiable,  but  this  was  due  to  the 
physical  effect  of  the  glycerol  in  making  the  emulsions  more  complete 
and  more  permanent  by  virtue  of  decreasing  the  surface  tension.  In 
his  investigations  upon  human  pancreatic  juice  Bradley34  found  that  the 
undiluted  juice  acted  on  ethyl  butyrate  less  rapidly  than  when  diluted 


STUDIES   ON    WATER   DRINKING.      VIII.    "V.C  21 

i  :  10.  The  optimum  dilution  was  found  to  lie  between  i  :  15  and 
i  :  20.  In  experiments  on  the  effect  of  bile  salts  on  pancreatic  juice 
Terroine35  found  that  the  action  was  a  physico-chemical  one,  directly 
upon  pancreatic  juice,  that  if  the  time  of  the  action  was  prolonged  diges- 
tion was  retarded,  and  that  if  still  more  prolonged  digestion  was  in- 
hibited. Shorter  periods  resulted  in  maximum  digestion. 

In  the  light  of  these  facts  the  better  absorption  and  more  complete 
utilization  of  the  fats  attendant  upon  water  ingestion  with  meals  are  a 
result  of  the  greater  completeness  of  the  hydrolytic  cleavage  under  the 
influence  of  dilution  and  of  the  accompanying  more  rapid  removal  of  the 
end-products. 

Summary. 

Experiments  were  performed  on  men  living  on  a  uniform  diet;  a  pre- 
liminary period  of  small  water  ingestion  was  followed  by  a  period  of  large 
water  ingestion  with  meals,  and  this,  in  turn,  by  a  final  period  with  the 
original  conditions. 

When  one  liter  of  water  additional  was  taken  with  meals  the  average 
daily  excretion  of  fat  in  the  feces  was  much  reduced  below  that  found 
when  a  minimum  amount  of  water  was  taken  with  meals;  one  and  one- 
third  liters  had  a  like  effect;  a  similar  but  less  marked  reduction  was 
observed  when  500  cc.  of  water  were  taken  with  meals. 

The  decreased  excretion  of  fat  observed  during  water  drinking  with 
meals  was  usually  evident  for  a  number  of  days  after  water  had  ceased 
to  be  taken  in  large  or  moderate  amounts  with  meals  indicating  that  the 
beneficial  influence  of  water  was  not  temporary  but  was  more  or  less 
permanent. 

A  slight  gain  in  weight  accompanied  the  water  drinking  and  this  gain 
was  not  subsequently  lost. 

After  several  months  of  moderate  water  drinking  with  meals  a  pro- 
nounced improvement  in  the  digestibility  of  fat  was  observed,  the  per- 
centage utilization  having  risen  from  94.3  to  96.5. 

The  better  digestion  and  absorption  of  fat  was  probably  due  to  the 
following  factors : 

(1)  Increased   secretion  of  gastric  juice  and   independently  of  pan- 
creatic juice  as  a  result  of  the  stimulating  action  of  water. 

(2)  Increased  acidity  of  the  chyme  bringing  about  a  more  active  secre- 
tion of  pancreatic  juice  and  bile. 

(3)  Increased  peristalsis  due  to  larger  volume  of  material  in  the  in- 
testin  and  increased  blood  pressure  due  to  rapidly  absorbed  water. 

(4)  A  more  complete  hydrolysis  of  the  fats  by  lipase  due  to  increased 
dilution  of  the  medium  and  consequent  more  rapid  absorption. 


22  STUDIES  ON  WATER  DRINKING.      VIII. 

REFERENCES. 

i.  Carrington,  "Vitality,  Fasting  and  Nutrition,"  p.  397  (Rebman,  N.  Y.,  1908). 
2.  Fischer,  "Physiology  of  Alimentation,"  p.  183  (Wiley,  1907).  3.  Pavlov,  "The 
Work  of  the  Digestive  Glands,"  translated  by  Thompson,  second  edition,  p.  112 
(Griffin  &  Co.,  London,  1910).  30.  Heidenhain,  quoted  by  Pavlov,  Ibid.,  p.  130. 
36.  Sanotskii,  quoted  by  Pavlov,  Ibid.,  p.  112.  4.  Foster  and  Lambert,  "Some  Factors 
in  the  Physiology  and  Pathology  of  Gastric  Secretion,"  /.  Exp.  Med.,  10,  820  (1908). 
5.  Pavlov,  Ibid.,  p.  144.  6.  Togami,  "Influence  of  Certain  Foods  and  of  Emotion  on 
Pancreas  Secretion,"  Z.  physik-didt.  Ther.,  12,453  (1908);  through  Biochem.  Centr.,  8, 
202.  6a.  Hawk,  Arch.  Int.  Med.,  8,  382  (1911).  7.  Wohlgemuth,  Berl.  klin.  Woch- 
schr.,  47,  92  (1910).  70,.  Fairhall  and  Hawk,  unpublished.  8.  von  Mering,  "Ueber 
die  Funktion  des  Magens,"  Verhandl.  des  Congresses  f.  innere  Med.,  12,  471-82  (1893). 
8a.  Cohnheim,  Munch,  med.  Wochschr.,  54,  2581  (1907).  86.  Kaufmann,  Z.  Heilk.,  28, 
203  (1907).  9.  Ruzicka,  "Ein  Selbstversuch  iiber  Ausnutzung  der  Nahrstoffe  bei  ver- 
schiedenen  Quantitaten  des  mit  dem  Mahle  eingefiihrten  Wassers,"  Arch.  Hyg.,  45,  409- 
16  (1902).  10.  Lusk,  "Science  of  Nutrition,"  second  edition,  p.  46  (Saunders,  1909). 
ioa.  Strasburger,  Z.  klin.  Med.,  46,  413-44  (1902).  n.  Schmidt  and  Strasburger,  "Die 
Faeces  des  Menschen,"  p.  i  (Berlin,  1905).  na.  Howe  and  Hawk,  unpublished.  116. 
Hattrem  and  Hawk,  Arch.  Int.  Med.,  7,  610(1911).  12.  Howe,  Rutherford  and  Hawk, 
"The  Preservation  of  Feces,"  Jour.  Am.  Chem.  Soc.  32,  1683-6  (1910).  13.  Schmidt  and 
Strasburger,  Ibid.,  p.  17.  130.  Mendel  and  Fine,  /.  Biol.  Chem.,  10,  309  (1911). 

14.  Kumagawa    and    Suto,     "Quantitative     Bestimmung    des     Fettes    und     der 
unverseifbaren  Substanzen  in  tierischem  Material,"  Biochem.  Z.,  8,  213-347  (1908). 

15.  Inaba,  "Fettbestimmungen   der  Faces    und   einigen   Nahrungsmittel    nach   der 
Methode    von   Kumagawa-Suto,"    Biochem.    Z.,   8,    348-55  (1908).     150.  Shimidzu, 
Biochem.    Z.,    28,    237-73    (1911).      16.    Hornborg,   dissertation   Helsingfors,    1903. 
Quoted  by  Hammarsten  (Mandel),  "Textbook  of  Physiological  Chemistry,"  p.  440 
(Wiley,  1911).     17.  Umber,  "Die  Magensaftsekretion  des  Menschen  bei  Scheinfutterung 
und  Rektalernahrung,"  Berl.  klin.  Wochschr.,  42,  56  (1905).     18.  Cade  and  Latarjet, 
Compt.  rend.  soc.  biol.,  57,  496  (1904).     19.  Bogen,  Arch.  ges.  Phys.  (Pfiuger),  117,  150 
(1907).     20.  Kaznelson,  "Scheinfutterungsversuche  am  erwachsenen  Menschen,"  Arch, 
ges.  Phys.  (Pftuger),  118,  327-52  (1907).     21.  Sommerfeld,  "Zur  Kenntniss  der  Magen- 
saftsekretion," Arch.  Kinderheilk.,  49,  1-15  (1909).     22.  Lavenson,  "Observations  on  a 
Child  with  Gastric  Fistula,"  Arch.  Int.  Med.,  4,  271-90  (1909).     23.  Hemmeter,  "Die 
Wirkung  der  Totalexstirpation  sammtlicher  Speicheldriisen,"  Biochem.  Z.,  n,  238-59 
(1908).     24.  Loevenhart  and  Hooker,  Proc.  Soc.  Exp.  Biol.  Med.,  5,  114-7  (1908).     240. 
Wills  and  Hawk,  Proc.  Am.  Soc.  Biol.  Chem.,  II,  p.  xxix  (1911).     25.  London  and 
Versilova,  "Die  Spaltung  emulgierter  Fette  im  Darmkanal   des  Hundes,"  Z.  physiol. 
Chem.,  56,  545-50  (1908).     26.  Levites,  "Verdauung  der  Fette  im  tierischen  Organ- 
ismus,"  Z.  physiol.  Chem.,  57,  46-8  (1908).     27.  Camus  and  Nicloux,  Compt.  rend.  soc. 
biol.,  68,  619-22  (1910).     28.  Stire,  Cent.  ges.  Phys.  Path.  Stoffvu.,  4,  889-90  (1909).     29. 
Terroine,  Compt.  rend.  soc.  biol.,  68,  439-41  (1910).     30.  Id,  Ibid.,  68,  518-20,  666-8 
(1910).     31.  Ury,  "Das  Vorkommen  von  gelosten  Substanzen  in  den  Faces  bei  gestei- 
gerter  Darmperistaltik,"  Salkowski  Festschr.,  385-96;  through  Jahresb.  Tierchem.,  34, 
518  (1904).     32.  Dobrovolskii,  Z.  physiol.   Chem.,  56,  408-16   (1908).     33.  Terroine, 
Biochem.  Z.,  23,  404-28  (1909).     34.  Bradley,  "Human  Pancreatic  Juice,"  /.  Biol. 
Chem.,  6,  133-71  (1909);  Ibid.,  8,  251  (1910).     35.  Terroine,  Compt.  rend.  soc.  biol., 
68»  754-5  (1910). 


STUDIES  ON  WATER  DRINKING:  IX.    THE  DISTRIBUTION  OF 

BACTERIAL  AND  OTHER  FORMS  OF  FECAL  NITROGEN  AND 

THE  UTILIZATION  OF  INGESTED  PROTEIN  UNDER  THE 

INFLUENCE  OF  COPIOUS  AND  MODERATE  WATER 

DRINKING  WITH  MEALS. 

H.  A.  MAT-TILL. 

Introduction. 

By  far  the  larger  part  of  the  organic  material  eliminated  in  the  feces 
is  of  unknown  nature  and  composition.  A  knowledge  of  the  source  of 
fecal  material  is  thereby  made  the  more  difficult  to  obtain.  Three  sources 
are  usually  considered  as  contributing  to  the  nitrogenous  material  ex- 
creted as  feces:  (i)  food  residues,  (2)  residues  of  the  digestive  juices  and 
cellular  material  from  the  intestinal  wall,  (3)  bacteria  and  their  products. 
Each  of  these  in  turn  has  been  emphasized  as  the  principal  contributing 
agent,  but  no  attempt  seems  ever  to  have  been  made  to  determin  the 
"nitrogen  partition"  in  the  feces. 

That  the  food  residues  of  an  available  diet  form  any  considerable  part 
of  the  excreted  material  has  had  to  be  denied  since  the  early  work  of 
Voit  on  fasting  feces.  In  feeding  expenmentr  on  dogs  this  investigator1 
showed  that  the  amount  of  nitrogen  in  the  feces  was  not  proportional 
to  the  amount  of  meat  fed.  No  muscle  fibers  or  protein  could  be  de- 
tected in  the  feces.  Voit2  showed  that  the  material  produced  in  an 
isolated  loop  of  the  intestin  of  a  dog  was  of  a  similar  composition  and  con- 
tained the  same  amount  of  nitrogen  as  the  feces  of  the  normal  intestin 
through  which  food  was  passing.  Prausnitz,*  in  experiments  on  men, 
showed  that  the  composition  of  the  feces  varied  with  the  diet  and  gave  a 
definition  of  normal  feces  as  those  resulting  from  the  eating  of  any  food 
that  is  completely  digested  and  absorbed.  His  data  also  show  that  the 
amount  of  nitrogen  in  the  feces  is  uninfluenced  by  the  amount  in  the  food, 
although  Schierbeck4  finds  considerable  variation  in  this  respect.  Rub- 
ner5  found  that  in  man  the  amount  of  feces  and  its  nitrogen  content 
are  determined  entirely  by  the  cellulose  content  of  the  diet.  In  the  same 
way  he  found  that  on  a  milk  diet  the  resulting  fecal  mass  was  almost 
directly  proportional  to  the  quantity  of  milk  ingested. 

It  is  entirely  probable  that  on  a  diet  whose  constituents  are  not  en- 
tirely available  the  amount  of  feces  is  increased  by  the  undigested  cellu- 
lose, and  the  nitrogen  content  is  increased  by  the  larger  amount  of  diges- 
tive juices  secreted  because  of  the  larger  volume  of  food  and  the  accom- 
panying increased  peristalsis. 

About  one- third  of  the  dry  matter  of  human  feces  consists  of  bacteria, 
and  at  least  one-half  of  the  nitrogen  of  feces  is  bacterial  in  its  origin. c'7'8 


24  STUDIES  ON  WATER  DRINKING.     IX. 

Little  is  known  as  to  the  conditions  upon  which  the  growth  of  the  intes- 
tinal flora  depends.  In  herbivora,  whose  food  materials  contain  large 
amounts  of  cellulose,  the  presence  of  organisms  that  bring  about  the  de- 
composition and  utilization  of  this  substance  is  an  advantage.  Even  so, 
only  45  per  cent,  of  the  energy  of  such  food  is  utilized.  In  the  intestin 
of  carnivora  the  existing  micro-organisms  are  limited  to  unabsorbed 
protein  and  the  residue  of  the  digestive  juices  for  their  food  supply.  In 
man,  living  upon  a  diet  that  contains  food  material  of  both  the  available 
and  the  unavailable  kind,  a  condition  midway  between  might  be  ex- 
pected, just  as  the  relative  length  of  the  intestin  lies  between  that  of 
herbivora  and  carnivora. 

A  recent  claim  of  Schottelius11  is  that  the  presence  of  bacteria  in  the  in- 
testin of  vertebrates  is  a  desirable  condition.  Among  their  functions 
are  the  f ollowing :  to  prepare  the  food  for  absorption,  to  stimulate  peris- 
talsis, to  inhibit  the  growth  of  pathogenic  bacteria,  and  to  render  the  body 
immune  to  bacterial  poisons  and  to  pathogenic  organisms  in  general. 
The  investigations  looking  toward  a  determination  of  the  possibility  of 
normal  life  with  a  steril  alimentary  canal  have  yielded  conflicting  re- 
sults;9'10 the  nature  of  the  animal,  of  its  food  and  its  digestive  mechanism 
are  all  important  factors  in  deciding  the  question. 

Since  the  supply  of  nutriment  for  the  bacteria  of  the  lower  intestin  must 
consist  mainly  of  the  nitrogenous  residues  of  the  digestive  juices  and  of  the 
unabsorbed  foodstuffs  that  reach  the  large  intestin,  we  should  expect 
a  decreased  bacterial  growth  when  this  food  supply  is  decreased.  An 
increase  in  unabsorbed  residues  of  digestive  juices  and  foodstuffs  should 
result  in  an  increased  bacterial  growth.  It  would  seem  reasonable  to 
suppose,  therefore,  that  any  influence  leading  to  the  incomplete  diges- 
tion and  absorption  of  food,  especially  of  its  protein  portion,  in  the  ali- 
mentary tract  would  result  in  increased  elimination  of  nitrogen  in  the 
feces,  or  in  increased  bacterial  growth  in  the  lower  intestin,  or  in  both 
of  these  conditions. 

It  was  thought  that  evidence  on  both  of  these  points  might  be  valua- 
ble in  determining  the  probable  effect  of  water  ingestion  with  meals. 

The  only  earlier  experimental  evidence  as  to  the  influence  of  water 
drinking  with  meals  upon  the  utilization  of  food  was  ob tamed  by  Ruzicka12 
in  an  experiment  upon  himself.  The  conditions  and  routine  of  his  ex- 
periment are  referred  to  in  the  previous  paper  on  the  utilization  of  fat. 
During  the  first  2 -day  period  of  his  experiment  when  no  water  was  taken 
with  the  meals,  118.4  g.  protein  were  ingested,  17.9  g.  excreted;  during 
the  second  2 -day  period  when  water  was  taken  with  the  meals,  125.9 
g.  protein  were  ingested,  16.5  g.  excreted.  Protein  utilization  was  84.9 
per  cent,  in  the  first  period  and  86.9  per  cent,  in  the  second.  Neith( 


STUDIES   ON   WATER   DRINKING.      IX.  25 

diet  nor  water  ingestion  was  sufficiently  uniform  to  allow  any   but  the 
most  general  conclusions  to  be  drawn. 

More  specific  evidence  comes  from  an  investigation  made  in  this  labora- 
tory by  Fowler  and  Hawk.11  Their  subject  was  brought  to  nitrogen 
equilibrium  on  a  constant  and  uniform  diet  and  continuing  this  diet 
one  liter  of  water  was  added  to  each  meal  for  a  time  of  five  days ;  this  was 
followed  by  a  short  final  period  in  which  the  original  conditions  held. 
It  appears  that  the  average  fecal  output  per  day  and  the  average  dry 
matter  per  day  in  the  feces  were  both  much  less  during  the  water  period 
than  during  either  of  the  other  periods,  and  that  the  average  amounts 
during  the  final  period  were  less  than  those  of  the  preliminary  period. 
More  detailed  examination  of  the  feces  was  confined  to  the  determina- 
tions of  total  and  bacterial  nitrogen  on  one  stool  in  each  of  the  three  periods. 
These  findings  showed  that  both  these  forms  of  nitrogen  were  much  re- 
duced in  amount  during  the  period  of  copious  water  ingestion  and  that 
after  water  ceased  to  be  used  in  unusual  amounts  these  values  did  not 
immediately  return  to  the  values  found  for  the  preliminary  period  but 
were  still  lower  than  those  during  the  final  period.  The  authors  con- 
cluded that  these  findings  indicated  a  more  economical  utilization  of  the 
protein  of  the  food.  During  the  water  period  of  five  days  the  subject 
gained  approximately  two  pounds  in  weight,  and  continued  to  gain  for 
a  number  of  months  after  the  end  of  the  experiment  and  the  return  to 
ordinary  mixed  diet.  It  could  not  be  said  that  the  water  drinking  had 
no  effect,  nor  that  it  had  an  ill  effect. 

These  conclusions  as  to  the  digestibility  and  availability  of  the  foods 
during  water-drinking  were  based  upon  analyses  of  but  three  stools, 
one  in  each  of  the  three  periods.  The  importance  of  the  conclusion 
reached  seemed  to  justify  more  extensive  experiments  along  the  same  line, 
experiments  in  which  each  individual  stool  of  the  whole  investigation 
should  be  subjected  to  similar  examination.  The  present  investigation 
was  therefore  planned  on  this  basis. 

Description. 

General  Plan. — The  general  plan  and  routine  of  the  experiment  has 
been  described  in  the  preceding  paper. 

Methods. — All  analyses  were  made  on  fresh  feces  without  previous 
drying.  The  samples  usually  weighed  out  with  the  approximate  weights 
were  as  follows : 

(a)  Two  2 -gram  samples  for  total  nitrogen. 

(6)  Two  2 -gram  samples  for  bacterial  nitrogen. 

(c)  Two  2 -gram  samples  for  acid-alcohol  extract. 

Total  Nitrogen. — During  the  earlier  experiments  dried  feces  were  used  for 
the  total  nitrogen  determinations,  with  unsatisfactory  results  due 
to  loss  of  nitrogen  during  the  drying.  That  there  is  such  a  loss  the 


26  STUDIES  ON  WATER  DRINKING.       IX. 

data  clearly  show;  this  has  been  observed  before.14'140  In  the  later  ex- 
periments the  determination  of  total  nitrogen  was  made  upon  the  fresh 
material  with  satisfactory  results. 

Bacterial  Nitrogen. — The  method  for  bacterial  nitrogen  is  described  in 
another  paper  from  this  laboratory.* 

Residue  Nitrogen. — As  explained  more  in  detail  under  the  determina- 
tion of  bacterial  nitrogen,  residue  nitrogen  is  that  which  comes  from  the 
well-washed  sediments  in  the  sedimentation  for  bacterial  nitrogen.  It 
represents  undigested  and  insoluble  nitrogen  that  occurs  in  the  larger 
particles  of  the  feces. 

Extractive  Nitrogen. — The  sample  for  acid-alcohol  extract  was  rubbed 
up  in  a  small  Erlenmeyer  flask  with  a  known  volume  of  95  per  cent, 
ethyl  alcohol  made  o .  2  per  cent,  acid  with  hydrochloric  acid.  The  flask 
was  stoppered  and  was  allowed  to  stand  at  room  temperature  for  a  week, 
being  shaken  up  at  least  once  each  day.  Nitrogen  was  then  determined 
on  an  aliquot  portion  (one-half)  of  the  alcohol  originally  added.  This 
represents  such  nitrogenous  end-products  as  are  below  the  proteose 
stage,  and  the  soluble  nitrogen  of  the  digestive  juices  and  of  the  pig- 
ments. Almost  invariably  this  amount  is  less  than  that  obtained  by  a 
similar  extractive  method  on  the  bacterial  sample  as  described  under 
bacterial  nitrogen.  This  may  be  due  to  the  greater  fineness  of  division 
that  is  secured  hi  the  case  of  the  latter  and  perhaps  also  to  the  solvent 
action  of  the  0.2  per  cent,  hydrochloric  acid  used  in  making  the  bac- 
terial suspensions. 

All  determinations  of  nitrogen  of  whatever  form  were  made  by  the 
Kjeldahl  method.  Instead  of  metallic  mercury,  copper  sulfate  was  used 
as  catalyst  in  the  digestion. 

Experiments  on  Copious  Water  Drinking  with  Meals. 

As  mentioned  before,  subjects  H  and  W  were  put  on  the  same  diet; 
the  amounts  had  to  be  altered  before  nitrogen  equilibrium  was  reached. 
The  quantity  and  composition  as  finally  given  were  as  follows: 

Amount 
(per  meal).  Nitrogen. 

Graham  crackers 150  grams  2 .087  grams 

Peanut  butter 20       "  0.882       " 

Butter 25       "  0.020       " 

Milk 450  (cc.)  2.360       « 


Total  5.349 

Protein 33-44  grams 

Protein  per  day 100 . 32 

On  this  diet  a  condition  of  nitrogen  equilibrium  was  attained  approx- 
*  Mattill  and  Hawk,  /.  Exp.  Med.,  14,  433  (1911). 


STUDIES  ON   WATER  DRINKING.      IX. 


imately  at  the  end  of  the  third  day.     The  exact  nitrogen  balance  may 
be  seen  from  the  following : 

Subject  H.      Nitrogen  in  feces 2 . 153 

Nitrogen  in  urine 14 .036 


Nitrogen  in  excreta 16 . 189 

Nitrogen  in  food 16 .046 


—0.143 

Subject  W.     Nitrogen  in  feces 2 . 385 

Nitrogen  in  urine 14 . 534 


Nitrogen  in  excreta 16.919 

Nitrogen  in  food 16 .047 


TABLE  I. — SUBJECT  W. 

Nitrogen  distribution. 


—0.873 

Percentage  of  total 
fecal  nitrogen  found  in. 


o 

d 

g 

i| 

2 

S3         5  « 

t* 

2 

1  • 

.2? 

'S 

"s  a 

V 

"S^ 

£,-*. 

w^i 

3 

**  S  So          °'.tJ 

ll 

|| 

it 

Hi 

!i 

Q.ri    °                        *    " 

y.-5      -oj-i 

wWc         -3,0 

55 

fe 

fe 

H 

I 

d                <! 

fc, 

I  

i  .738 

I.9II 

1-737 

0-445 

tii 

l-g-^ 

2  

•2     . 

2-333 
O  9  ^  S 

2.536 

o  061 

2.305 
0.874. 

0-599 
o.  193 

l*n 

A 

I   64.0 

**  -  V     -1 
I    74.7 

*j  +  **f*f 

i   588 

0.586 

m 

*  .  ^^y 

•  '  /T-/ 

•  -  o«« 

Total 6.633     7-J55     6.504 

Average.   2.211     2.385     2.168 


1.823 

1.279     0.889     0.608 
(calc.)   (calc.) 


23.3 
23.6 

20.1 

33-5 


25-5 


c.  . 

(T 

.387) 

I  .  2Q6 

0.280 

15.2 

i 
v< 

6  

7 

0.301 

I    ^7 

0 

i 

.287 

All 

0.268 

I    ^Q 

0.085 
o  4.16 

28.2 
2Q  .O 

y 

t{  10 

g 

8  

1.499 
1-653 
O.  554 

1-593 
1.771 
O-6AO 

1.489 
I.655 

o.  598 

0.402 

0.458 

o.  175 

25-2 

25-9 
27.3 

9  
10.  .  . 

Total.  .  .  . 
Average  . 

0.784 

0-545 

7 
(i 

.III 

.422) 

6.645 
1.329 

2.401 
0.480 

33-4 

(calc.) 

(calc.) 

-o 

ii. 

I    4IO 

T 

JCQ 

I    ^64. 

o  817 

O    54.7 

o  4.56 

56.O 

37  .  5 

31  .2 

II 

12  

1.805 

I 

.896 

1.772 

0.970 

0.802 

0.571 

51.2 

42-3 

30.1 

M 

(S  ro 

I  -a.  . 

0.448 

(o 

.431) 

0.403 

0.294 

o.  109 

0.122 

65-6 

24-3 

27.2 

j3 

14  

1.329 

I 

•499 

I.40I 

0.866 

0.535 

0.373 

57-8 

35-7 

24.Q 

Total  

4.992 

5 

.286 

4-940 

2.947 

1.993 

1.522 

Average  . 

1.664 

i 

.762 

1.647 

0.982 

0.664 

0.507 

55-7 

37-7 

28.8 

0.972 

0.675 

(calc.) 

(calc.) 

28  STUDIES  ON  WATER  DRINKING.       IX. 

Discussion  of  Data  from  Subject  W,  Table  I. — As  mentioned  before 
the  determinations  of  fecal  nitrogen  in  this  experiment  were  unsatisfac- 
tory because  of  the  loss  of  volatil  nitrogenous  compounds  in  drying. 
That  nitrogen  was  lost  is  very  evident  from  the  values  of  bacterial  + 
soluble  nitrogen  which  are  in  almost  all  cases  larger  than  the  correspond- 
ing total  nitrogen.  The  so-called  bacterial  +  soluble  nitrogen  comes 
from  the  determination  of  bacterial  nitrogen  and  its  significance  will  be 
clear  by  referring  to  the  description  of  the  method  as  given  in  a  recent 
article.1  If  the  acid  suspension  after  removing  the  last  sediment  of  non- 
bacterial  substance  is  not  treated  with  alcohol,  but  is  directly  transferred 
to  Kjeldahl  flasks,  the  nitrogen  so  determined  is  not  only  bacterial  but 
includes  in  addition  all  nitrogen  that  is  soluble  in  0.2  per  cent,  hydro- 
chloric acid  or  that  has  become  so  during  the  time  of  manipulation.  This 
datum  is  spoken  of  as  bacterial  +  soluble  nitrogen.  In  later  experi- 
ments it  was  shown  that  the  ratio  of  total  nitrogen  to  bacterial  +  soluble 
was  fairly  constant  at  i .  10  in  the  preliminary  period  and  i  .07  in  the  fol- 
lowing periods.  Applying  this  factor  to  the  values  under  bacterial  + 
soluble  nitrogen  the  values  under  fecal  nitrogen  (calc.)  are  obtained. 
Although  these  are  not  values  obtained  by  analysis,  they  are  more  cor- 
rect than  those  actually  obtained  for  the  reasons  given.  Taking  either 
of  these  values,  however,  the  average  daily  amount  of  total  nitrogen 
excreted  during  the  water  period  is  only  two-thirds  of  the  average  daily 
amount  excreted  during  the  preliminary  period,  and  about  four-fifths 
the  average  daily  amount  of  the  final  period.  The  average  daily  amount 
in  the  final  period  is  only  slightly  higher  than  that  of  the  water  period, 
and  only  three-fourths  of  what  it  was  in  the  preliminary,  showing  that  the 
good  effect  of  the  water  is  not  immediately  lost. 

The  question  as  to  the  kind  of  fecal  nitrogen  that  was  decreased  in 
amount  cannot  be  answered  on  the  basis  of  analytical  data,  since  the 
bacterial  and  acid-soluble  nitrogen  were  not  separated  during  the  early 
part  of  the  experiment.  From  later  experiments  in  which  this  separa- 
tion was  made,  a  factor  was  calculated  and  found  to  be  very  uniform  for 
different  subjects  throughout  the  various  periods.  On  this  basis  59 
per  cent,  of  the  combined  bacterial  +  soluble  nitrogen  is  nitrogen  be- 
longing to  bacterial  substance.  That  the  factor  as  applied  does  not 
fall  far  short  of  representing  actual  conditions  may  be  gathered  from  the 
close  agreement  between  the  calculated  values  and  those  obtained  by 
actual  analysis  of  the  stools  of  the  final  period.  Applying  this  factor  to 
the  values  for  combined  bacterial  +  soluble  nitrogen  the  nitrogen  of 
bacterial  substance  in  the  preliminary  period  was  i .  2  79  grams  per  day, 
in  the  water  period  0.784  gram  per  day,  and  in  the  final  period  0.972 
gram  per  day.  These  values  indicate  that  bacterial  nitrogen  was  de- 
1  Mattill  and  Hawk,  /.  Exfi.  Med.,  14,  433  (1911). 


STUDIES  ON   WATER  DRINKING.      IX.  29 

creased  under  the  influence  of  copious  water  drinking  and  furthermore, 
in  common  with  the  results  found  for  total  fecal  nitrogen,  this  condition 
was  not  transitory  but  more  or  less  permanent.  The  same  statement 
may  be  made  regarding  the  nitrogen  soluble  in  o .  2  per  cent,  hydrochloric 
acid.  The  acid-alcohol-soluble  nitrogen  averaged  25.5  per  cent,  of  the 
total  fecal  nitrogen  during  the  preliminary  period,  33.4  per  cent,  during 
the  water  period,  and  28.8  per  cent,  during  the  final.  This  may  mean 
that  the  digestion  during  the  water  period  resulted  in  nitrogenous  end 
products  which  are  more  soluble.  This  increased  percentage  of  acid- 
alcohol-soluble  nitrogen  in  the  feces  during  the  water  period  does  not  in- 
dicate decreased  absorption,  for  the  absolute  amount  of  this  form  of  nitro- 
gen in  the  feces  is  decreased  from  o .  608  gram  during  the  preliminary  period 
to  o .  480  gram  in  the  water  period  and  rizes  only  slightly  above  this  value, 
o .  507  gram,  during  the  final  period,  showing  that  absorption  of  the  solu- 
ble end  products  is  more  complete  under  the  influence  of  water.  More 
probably,  however,  this  form  of  nitrogen  represents  the  residual  portion 
of  digestive  and  intestinal  juices  which  are  known  to  increase  in  amount 
under  the  influence  of  water  ingestion,  especially  the  gastric  and  pan- 
creatic secretions  and  the  bile.  If  this  is  so,  it  is  a  very  important  fact, 
for  even  though  during  copious  water  ingestion,  the  flow  of  these  secre- 
tions is  stimulated,  and  as  a  result  of  increased  peristalsis  the  amount 
of  cast-off  cellular  material  in  the  intestin  is  increased,  the  amount  of 
fecal  nitrogen  instead  of  being  increased,  as,  indeed,  it  must  be  from  these 
sources,  is,  on  the  contrary,  actually  decreased.  It  follows  from  this  that 
the  digestibility  of  protein  material  during  a  period  of  copious  water- 
drinking  was  increased  even  beyond  what  the  data  indicate,  since  part 
of  the  excreted  nitrogen  is  known  to  come  from  the  larger  amounts  of 
digestive  juices  secreted  under  the  stimulating  influence  of  water. 

Discussion  of  Data  from  Subject  H,  Table  II. — The  values  for  total  fecal 
nitrogen,  either  those  determined  directly  on  dry  feces  or  those  calcula- 
ted directly  from  the  bacterial  -f  soluble  nitrogen,  show  that  the  average 
daily  excretion  of  nitrogen  was  i .  833  g.  (detd.)  during  the  preliminary 
period,  1.442  g.  during  the  water  period,  and  1.636  g.  during  the  final 
period.  It  was  thus  much  less  during  the  water  period  than  during 
either  of  the  others,  and  the  average  daily  amount  after  the  water  was 
less  than  that  before  it. 

As  with  subject  W,  the  kinds  of  fecal  nitrogen  that  suffered  a  decrease 
cannot  be  stated  on  the  basis  of  analysis.  The  results  on  applying  to 
the  value  for  bacterial  +  soluble  nitrogen  the  factor  0.59,  which  was  ob- 
tained from  later  experiments,  as  has  been  explained,  show  that  the  aver- 
age bacterial  nitrogen  per  day  was  decreased  from  i .  155  in  the  prelimi- 
nary to  0.875  m  the  water  period,  rizing  to  1.044  in  the  final.  The 
average  daily  output  as  determined  for  the  final  period  is  i .  128,  showing 


30  STUDIES  ON  WATER  DRINKING.      IX. 

that  the  factor  used  is  accurate.  The  same  proportionate  differences  are 
to  be  noticed  in  the  values  for  soluble  nitrogen.  It  is  evident  that  both 
bacterial  and  soluble  nitrogen  in  the  feces  underwent  a  marked  decrease 
during  the  period  of  copious  water  drinking. 

TABLE  II. — SUBJECT  H. 

~  Percentage  of  total  fecal 

Nitrogen  distribution.  nitrogen  found  in 


1 

| 

-o          -A           ^ 
2  2          o           03 

•£•3 

it 

2 

i 

fc*     . 

c 

1   C                     .                p  fl 

•  fl 

~         -° 

Number 

p 

p 

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in  i!  :§f 

N            m           o 

•?3a 

5    1 

*>              " 

«     2 

»        a 

^ 

j 

o  6^6 

o  743 

o  675 

o  208 

28  o 

2.  ... 

I  .214 

i  .427 

I  .207 

o  342 

24.0 

2    2O6 

2  654 

2    417 

O   7^6 

28.  «> 

1  .44'? 

1.486 

70.0 

Total 5.499     6.459     5.871  1.959 

Average 1-833     2.153     1.957     i-i55     0.802     0.653  3°. 3 

(calc.)    (calc.) 


O    "»I4 

0.537 

0.502 

o 

.280 

52  .  I 

Wits'  on 

6        .     . 

1  .  113 

i  .240 

I    l6? 

n 

AAn 

TC    8 

ill 

7 

o  695 

O    76l 

O   71  1 

o  238 

•71      -J 

p£S 

8  

^  .602 

3.366 

T  .  T7A 

9  

1.563 

1.788 

1.671 

0 

.655 

36.6 

Total      .    ... 

.    7.2IO 

7  .0^7 

7  .417 

0 

.754 

Average  

.     I  .442 

I  .  587 

I  .48^ 

0.875 

O.6O8 

O 

.  551 

74..  7 

(calc.) 

(calc.) 

10  

1.229 

I.4I5 

1.322 

0.819 

0.503 

O 

•503 

57-9 

35-6 

35-6 

iH 

ii  

0.442 

0.477 

0.446 

0.302 

0.144 

0 

.119 

63-3 

30.2 

24.9 

SK. 

12  

1.510 

1.763 

1.648 

1.082 

0.566 

0 

•563 

61  .4 

32.1 

31-9 

13  

1.726 

2.028 

1.895 

1.180 

0.715 

0 

.67i 

58.2 

35-3 

33.1 

Total  

4.907 

5.683 

5.3H 

3-383 

1.928 

I 

.856 

Average 

i  636 

I    8Q4. 

I    77O 

i   128 

o  647 

o 

610 

cq  6 

7A    o 

•2,2    7 

1.044 

0.726 

(calc.) 

(calc.) 

The  percentage  of  acid-alcohol-soluble  nitrogen  rose  from  an  average 
of  30 . 3  in  the  preliminary  to  34 . 7  during  the  water  period  and  fell  to 
32.7  in  the  final,  while  the  actual  amount  fell  from  0.653  in  the  prelim- 
inary to  0.551  in  the  water  and  rose  to  0.619  gram  per  day  hi  the  final 
period.  The  actual  amount  of  this  form  of  nitrogen  was  considerably 
decreased  under  the  influence  of  water  drinking.  The  suggestion  may 
be  made  again  that  the  increased  percentage  output  was  probably  due 
to  the  increased  volume  of  digestive  juices,  the  secretion  of  which  was 
stimulated  by  the  ingestion  of  water. 


STUDIES   ON   WATER   DRINKING.      IX  31 

Summary. 

The  findings  on  both  subjects  in  this  experiment  show  a  decreased 
elimination  of  all  forms  of  fecal  nitrogen  during  the  period  in  which  water 
(1000  cc.  additional)  was  taken  with  each  meal.  No  ill  effects  could  be 
seen  and  the  beneficial  effect  of  water  was  not  temporary  but  was  pro- 
longed beyond  the  time  during  which  water  was  taken. 

Experiments  on  Moderate  Water  Drinking  with  Meals. 

In  the  experiments  upon  protein  utilization  under  the  influence  of  a 
water  ingestion  of  500  cc.  with  each  meal,  the  same  general  methods 
were  employed.  Total  nitrogen  determinations  were  made  on  the  fresh 
moist  material  and  the  loss  in  volatil  nitrogen  compounds  due  to  dry- 
ing was  thus  avoided.  A  more  accurate  and  trustworthy  separation 
of  the  bacterial  +  soluble  nitrogen  was  made  by  an  efficient  centrifuga- 
tion  of  the  final  alcohol  suspension  from  which  the  clear  liquid  had  been 
pipetted  off.  The  nitrogen  of  the  precipitated  material  could  more  truly 
be  called  bacterial  nitrogen,  that  of  the  liquid,  acid-soluble  nitrogen. 

On  the  basis  of  the  experience  gained  in  this  and  similar  investigations 
we  cannot  agree  with  certain  statements  made  recently  by  Mendel  and 
Fine1  as  to  the  determination  of  the  total  nitrogen  content  of  feces.  They 
say:  "The  error  incident  to  this  procedure  (drying),  however,  did  not  ap- 
pear to  us  to  warrant  serious  attention,  at  least  until  certain  details  of 
metabolism  operations,  such,  e.  g.,  as  the  accurate  division  of  feces  be- 
longing to  successive  periods,  reaching  a  higher  stage  of  perfection."  If 
we  examin  Tables  I  and  II  of  the  present  paper  it  will  be  observed  that 
the  values  obtained  by  us  for  the  combined  bacterial  and  soluble  nitrogen  of 
fresh  feces  are  in  nearly  every  instance  larger  than  the  total  nitrogen  values 
obtained  from  the  analysis  of  the  same  feces  after  drying.  We  are  firmly 
convinced  that  the  ideal  method  of  feces  analysis  embraces  the  examina- 
tion of  the  individual  stools  in  the  fresh  condition.  This  procedure,  of 
course,  entails  much  more  labor  than  the  less  accurate  practice  of  utilizing 
the  dried  feces,  but  we  believe  that  the  added  accuracy  richly  compen- 
sates the  investigator.  In  certain  connections  the  individual  fresh  stools 
may  be  preserved  for  several  days  and  an  analysis  made  of  a  composit 
sample  of  the  moist  feces.146 

Throughout  most  of  this  experiment  the  values  for  bacterial  nitrogen 
and  for  nitrogen  in  the  alcohol  extract  of  bacteria,  that  is  the  acid-solu- 
ble nitrogen,  were  determined  along  with  a  determination  of  the  bac- 
terial +  soluble  nitrogen,  that  is,  the  same  suspension  without  alcohol 
treatment.  The  agreement  between  the  last-named  and  the  sum  of  the 
first  two  is  very  satisfactory ;  in  almost  all  cases  they  would  pass  as  dupli- 
cates. The  fact  that  the  alcohol  used  was  not  previously  freed  from  pos- 
1  Mendel  and  Fine,  /.  Biol.  Chem.,  10,  309  (1911). 


32  STUDIES  ON  WATER  DRINKING.      IX. 

sible  traces  of  nitrogen  may  account  for  the  uniformly  higher  values 
given  by  the  sum  of  the  separate  alcohol-soluble  and  bacterial  determina- 
tions. 

It  was  found  from  these  data  that  the  bacterial  nitrogen  was  59  per 
cent,  of  the  combined  bacterial  +  soluble  nitrogen  and  this  ratio  was 
used  in  the  preceding  experiment.  The  ratio  of  total  fecal  nitrogen  to 
bacterial-soluble  nitrogen  used  in  the  first  experiment  was  obtained  from 
the  values  for  these  forms  in  this  experiment.  In  both  Tables  III  and 
IV  this  was  approximately  i .  10  in  the  earlier  periods  and  1.07  in  the 
later  periods. 

Acid-alcohol-soluble  nitrogen  was  determined  as  before,  and  the  de- 
termination of  residue  nitrogen  was  made  throughout  this  experiment. 

The  diet  of  subject  W,  who  had  served  before,  was  slightly  reduced 
from  what  it  had  been  in  the  preceding  experiment.  The  amounts  and 
composition  were  as  follows : 

Amount  (per  meal).  Nitrogen. 

Graham  crackers 125  grams  i .  776  grams 

Peanut  butter 20"  0.868       « 

Butter 25"  0.015       " 

Milk 400  (cc.)  1.917       " 

4-577 

Protein 28 .61 

Daily  protein 85 . 83 

The  diet  of  subject  E   consisted   of 

Graham  crackers 150  grams  2 . 120  grams 

Peanut  butter 20       a  0.868       " 

Butter 25       "  0.015 

Milk 400  (cc.)  1-917       " 


4.920 

Protein 3° .  75 

Daily  protein 92 . 25 

For  water  ingestion  see  preceding  paper. 

Discussion  of  Data  from  Subject  W,  Table  III. — Because  of  the  difficulty 
experienced  hi  obtaining  nitrogen  equilibrium  the  preliminary  period 
of  W  was  divided  by  taking  charcoal  on  the  eighth  day,  but  with  no 
change  in  diet.  On  the  i3th  day  W's  nitrogen  balance  was  as  follows: 

Nitrogen  in  feces i .  360 

Nitrogen  in  urine 12 . 361 

Nitrogen  in  excreta 13-721 

Nitrogen  in  food 13  •  731 

+  0.010 


STUDIES   ON   WATER   DRINKING.      IX.  33 

The  influence  of  a  restricted  amount  of  water  and  the  latent  period 
after  which  its  effects  appeared,  as  explained  in  the  previous  paper,  are 
to  be  noted  in  the  protein  utilization  as  they  were  hi  the  fat  utilization. 
The  average  daily  fecal  nitrogen  excretion  during  the  first  part  of  the  pre- 
liminary period  rizes  from  i .  275  to  i .  360  in  the  second  part,  bacterial  -f 
soluble  nitrogen  from  1. 142  to  1.233,  acid-alcohol-soluble  from  0.284  to 
0.320,  and  residue  nitrogen  from  o.  148  to  o.  154.  A  comparison  of  the 
nitrogen  data  of  this  preliminary  period  with  the  nitrogen  data  of  the  pre- 
liminary period  of  the  first  experiment  shows  the  average  daily  total 
fecal  nitrogen  output  to  be  2 . 385  in  the  first  as  against  i .  275  in  the  sec- 
ond; bacterial  +  soluble  nitrogen  2. 168  in  the  first  as  against  i .  142  in 
the  second;  acid-alcohol-soluble  0.608  as  against  0.284.  The  average 
percentage  utilization  of  protein  in  the  first  experiment  was  86.3  per 
cent,  as  against  90 . 7  per  cent,  in  the  second.  These  data  showing  so 
pronounced  an  improvement  in  the  digestion  and  utilization  of  protein 
are  on  an  individual  living  on  the  same  kind  of  diet,  but  separated  by  a 
period  of  three  months  in  which  water  drinking  with  ordinary  meals 
was  practised. 

With  the  fourteenth  day  500  cc.  of  water  were  added  to  the  diet  of 
of  each  meal  and  this  was  continued  for  ten  days.  A  five-day  period  fol- 
lowed in  which  the  original  conditions  prevailed. 

By  referring  to  Table  III  it  will  be  seen  at  once  that  the  nitrogen  of  the 
various  periods  presents  no  striking  differences. 

The  values  for  total,  bacterial  and  other  forms  show  fluctuations  which 
are  too  small  to  admit  of  conclusions.  The  largest  proportionate  varia- 
tion is  seen  in  the  residue  nitrogen.  This,  as  was  explained,  was  ob- 
tained from  the  solid  material  that  was  sedimented  in  the  procedure 
for  bacterial  nitrogen.  Its  percentage  of  the  total  nitrogen,  11.3,  in  the 
preliminary  period,  fell  to  9.5  in  the  water  period,  and  still  lower,  to 
8.2  in  the  final  period.  If  these  small  differences  are  significant,  they 
point  to  a  condition  of  better  digestion. 

Discussion  of  Data  from  Subject  E,  Table  IV. — On  the  diet  given,  the 
nitrogen  balance  of  Subject  B  at  the  end  of  the  sixth  day  was  as  follows : 

Nitrogen  in  feces i .  926 

Nitrogen  in  urine 13 . 310 

Nitrogen  in  excreta 15 . 246 

Nitrogen  in  food 14.761 


—0-485 

An  examination  of  the  data  in  Table  IV  again  reveals  no  striking  differ- 
ences in  the  nitrogen  values  from  one  period  to  another.  The  variations 
in  average  daily  amounts  of  nitrogen  in  its  various  forms  are,  as  in  the 
case  of  W,  too  small  to  be  significant,  with  the  possible  exception  of  the 


34 


STUDIES  ON  WATER  DRINKING.      IX. 


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STUDIES  ON  WATER  DRINKING.  IX. 


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STUDIES  ON  WATER  DRINKING.      IX. 


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38  STUDIES  ON  WATER  DRINKING.      IX. 

values  for  the  residue  nitrogen.  The  percentage  of  the  total  nitrogen 
found  in  this  form  during  the  preliminary  period,  n.i,  fell  to  10.2  in 
the  water  period  and  rose  to  10. 9  in  the  final.  Similar  variations,  and  in 
the  same  direction,  were  noted  with  W.  Attention  may  be  called  again 
to  the  satisfactory  agreement  of  the  values  for  bacterial  +  soluble  nitro- 
gen with  the  values  of  the  sum  of  these  two  determined  separately,  which 
thus  furnishes  a  valuable  check  on  the  determinations. 

The  protein  data  on  Subjects  W  and  E  during  this  experiment  on 
moderate  water  drinking  with  meals  do  not  justify  the  drawing  of  any 
but  negative  conclusions ;  they  do  not  show  that  the  use  of  water  was 
attended  by  any  undesirable  results.  The  data  obtained  on  the  utiliza- 
tion of  carbohydrate  and  fat  during  this  period,  which  are  presented  in 
the  following  and  preceding  papers,  show  that  where  analytical  methods 
are  sufficiently  exact  to  give  significant  results  the  effect  of  moderate 
water  drinking  is  in  the  same  direction  as  that  of  copious  water  drinking, 
though  much  less  marked. 

Copious  Water  Ingestion  by  an  Individual  Accustomed  to  Taking 

Considerable  Water  with  Meals. 

Following  the  preceding  experiment,  a  period  of  six  days  formed  the 
preliminary  period  for  this  experiment,  the  subject  of  which  was  E. 
The  diet  was  the  same  as  before  and  at  the  beginning  of  the  5 -day  water 
period  the  nitrogen  balance  was  as  follows : 

Nitrogen  in  feces i .  957 

Nitrogen  in  urine 12 .775 

Nitrogen  in  excreta 14 . 732 

Nitrogen  in  food 14. 761 

+  0.029 

Discussion  of  Data  on  Subject  E,  Table  V. — Although  both  carbohydrate 
and  fat  data  (discussed  in  other  places)  show  differences  that  signify  an 
increased  utilization  of  these  foodstuffs  during  the  ingestion  of  one  and 
one-third  liters  of  water  additional  with  each  meal,  a  comparison  of  the 
data  on  the  excretion  of  nitrogen  in  its  various  forms  during  the  three 
periods  of  this  experiment  allows  no  positive  conclusions  to  be  drawn. 
The  differences  are  too  small  to  be  significant.  A  negative  conclusion, 
however,  is  entirely  justifiable,  when  it  is  seen  that  the  absorption  of 
over  four  liters  of  water  during  the  day,  and  most  of  this  taken  during 
the  meals,  had  no  untoward  effect  upon  the  digestion  and  absorption 
of  the  food.  The  probable  reason  for  the  fact  that  no  change  in  the  direc- 
tion of  better  digestion  could  be  noticed  is  that  Subject  E  habitually 
took  considerable  amounts  of  water  with  his  meals,  and  the  experimental 
conditions  were  thus  little  different  from  the  usual  regime. 


STUDIES  ON   WATER   DRINKING.      IX. 


39 


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40  STUDIES  ON  WATER  DRINKING.       IX. 

General  Discussion. 

The  general  conclusion  from  all  these  findings  is  that  during  water  in- 
gestion  with  meals  there  is  a  better  digestion  and  a  more  complete  util- 
ization of  the  protein  food  and  that  this  effect  is  much  less  marked  with  a 
small  water  ingestion  than  with  a  large  one.  It  is  also  more  or  less  per- 
manent, with  the  result  that  in  an  individual  accustomed  to  taking  con- 
siderable water  with  meals  the  effects  of  decreasing  or  increasing  the  vol- 
ume ingested  are  not  immediately  obvious. 

There  is  one  objection  to  the  conclusion  that  this  is  caused  by  water 
drinking.  It  has  frequently  been  observed  in  experiments  on  men  that 
the  prolonged  administration  of  a  given  diet  causes  the  enzyme  content 
of  the  digestive  juices  so  to  change  as  to  be  best  adapted  to  digesting 
the  food.  It  might  be  argued,  therefore,  that  although  the  food  was  as 
well  digested  during  the  latter  part  of  these  experiments  as  in  the  be- 
ginning, this  was  a  result  of  adaptation  which  counteracted  the  unde- 
sirable effects  of  water  drinking.  A  comparison  of  the  data  of  the  final 
periods  with  those  of  the  water  periods  is  sufficient  to  show  that  the  with- 
drawal of  water  was  accompanied  by  a  pronounced  change  in  favor  of 
the  water  drinking,  or  by  no  appreciable  change  in  digestibility  and  util- 
ization. 

Any  supposed  effect  of  adaptation  is  also  counterbalanced  by  the 
effect  of  loss  of  appetite  due  to  the  monotony  of  the  diet.  Ixmdon  and 
Pevsner15  found  that  in  dogs  the  stomach  contents  were  more  rapidly 
passed  on  to  the  duodenum  when  the  factor  of  appetite  was  present  than 
when  it  was  absent.  They  conclude  that  the  larger  amount  of  secretion, 
that  is,  the  appetite  juice,  was  the  cause.  If  there  is  any  increased  effi- 
ciency in  "appetite"  juice  over  the  ordinary  secretion  in  man  then  the 
digestive  power  of  all  the  juices  is  at  least  not  increased  by  the  factor 
of  appetite  after  partaking  of  over  one  hundred  meals  that  were  abso- 
lutely uniform  in  the  kind  and  quantity  of  food  they  contained. 

Evidence  has  been  adduced  in  another  place  to  show  that  the  action 
of  water  is  not  such  as  to  cause  undigested  food  particles  to  be  washed 
through  the  pylorus  prematurely,  and  thereby  place  a  more  than  pro- 
portionate burden  upon  the  lower  digestive  tract.  That  a  premature 
opening  of  the  pylorus,  resulting  hi  a  shortening  of  gastric  digestion, 
is  uneconomical,  has  been  shown  by  Cohnheim.16  The  importance  of 
the  stomach  in  protein  digestion  is  not  clear  despite  extensive  experi- 
mentation bestowed  upon  the  subject. 

London  and  Polovzova17'  18  found  that  with  but  few  exceptions  proteins 
are  not  absorbed  in  the  stomach,  but  that  with  few  exceptions  most  pro- 
teins are  made  soluble  in  the  stomach  to  about  78  per  cent.,  the  ratio  be- 
tween proteoses,  peptones  and  residual  substances  being  59.3,  32.9,  7.8. 
The  soluble  products  of  gastric  digestion  are  quickly  attacked  by  the  in- 
testinal juices.  Examination  of  stomach  contents19  reveals  the  fact 
that  peptones,  peptides  and  amino  acids  may  be  absorbed;  while  it  is 


STUDIES   ON   WATER   DRINKING.      IX.  4! 

shown  that  the  enzymes  of  the  stomach  have  the  ability  completely  to 
hydrolyze  proteins  to  these  end-products,  yet  it  is  also  shown  that  the 
length  of  time  which  pepsin  requires  to  bring  this  about  is  far  in  excess 
of  the  time  in  which  protein  remains  in  the  stomach. 

The  importance  of  the  stomach  in  protein  assimilation  has  been  em- 
phasized recently  by  Carrel,  Meyer  and  Levene,20  who  showed  that  after 
removal  of  the  larger  part  of  the  small  intestin,  although  the  absorption 
of  ingested  protein  is  diminished,  the  rate  of  assimilation  and  retention  of 
the  absorbed  protein  follows  the  same  course  as  in  normal  animals.  They 
conclude  that  the  stomach  and  not  the  intestin  is  the  most  important 
organ  for  protein  assimilation.  London  and  Dmitriev21  showed  that  the 
removal  of  the  small  intestin  in  a  dog  results  in  the  death  of  the  animal 
in  about  five  weeks.  Ordinarily,  if  as  much  as  seven-eighths  of  the  small 
intestin  is  removed,  carbohydrate  and  especially  protein  assimilation 
rapidly  return  to  normal  but  not  so  with  the  assimilation  of  fat.  Some- 
what similar  results  have  been  obtained  by  Underbill.22  After  resection 
of  80  per  cent,  of  the  small  intestin  Axhausen23  found  that  the  absorp- 
tion of  protein  as  well  as  of  fat  was  very  much  lower  than  normal.  Re- 
sults obtained  after  experimental  removal  of  various  portions  of  the  ali- 
mentary tract  are  always  subjected  to  this  correction  that  the  different 
organs  may  change  their  function  and  character  in  the  direction  of  com- 
pensation. Thus,  after  gastrectomy  in  dogs,  Carrel,  Meyer  and  Levene24 
observed  a  high  nitrogen  retention  which  disappeared  in  ten  to  twelve 
weeks  after  the  operation.  The  explanation  suggested  is  that  the  pan- 
creatic and  intestinal  secretions  that  are  minimal  immediately  after 
gastrectomy  return  to  normal  at  a  later  period  and  protein  is  again  fully 
digested  before  absorption.  They  also  note  a  hypertrophy  of  the  upper 
end  of  the  duodenum  after  gastrectomy. 

Since  the  presence  of  water  along  with  food  in  the  stomach  is  hardly  of 
long  enough  duration  to  affect  either  the  food  or  the  mucous  membrane, 
the  changes  for  the  better  digestion  and  utilization  of  the  protein  ma- 
terial that  have  been  observed  must  take  place  principally  in  the  intes- 
tin. Some  experimental  work  has  been  done  on  the  absorption  of  pro- 
teins by  living  membranes.  Zunz25  in  experiments  on  dogs  upon  protein 
digestion  and  absorption  in  the  stomach  and  small  intestin  in  situ  has 
shown  that  the  osmotic  pressure  of  the  solutions  of  protein  introduced 
scarcely  changes  in  the  stomach  when  this  is  tied  off,  but  in  the  small 
intestin  it  tends  toward  that  of  the  blood  and  usually  becomes  lower 
than  this.  Surface  tension  is  lower  than  that  of  the  blood  in  both  the 
stomach  and  intestin.  With  low  proteose  content  the  surface  tension 
decreases  in  both  regions.  In  the  intestin,  Zunz  concludes,  the  digestive 
processes  tend  to  bring  the  concentration,  osmotic  pressure  and  surface 
tension  of  the  contents  to  the  optimum  for  absorption.  The  organism 
itself  seems  to  strive  to  secure  a  dilution  of  the  products  of  digestion 
such  that  they  can  be  most  readily  and  completely  absorbed. 


42  STUDIES  ON  WATER  DRINKING.       IX. 

The  phenomena  of  absorption  still  lack  a  unifying  physical  explanation ; 
in  fact,  each  investigation  seems  to  disclose  new  and  unknown  factors. 
Filtration,  osmosis,  the  selective  action  of  membranes  and  the  nature 
and  behavior  of  colloids  are  some  of  the  important  factors,  upon  an  un- 
derstanding of  which  the  solution  of  the  many  problems  depends. 

Conclusions. 

Without  attempting  to  suggest  any  further  explanations  than  those 
given  at  the  end  of  the  preceding  paper,  it  may  be  said  that  the  ingestion 
of  large  amounts  (1000  cc.)  of  water  with  meals  caused  the  protein  con- 
stituents of  the  food  to  be  more  completely  utilized,  as  shown  by  a  de- 
crease in  all  forms  of  nitrogen  in  the  feces,  including  bacterial,  0.2  per 
cent,  hydrochloric-acid-soluble,  acid-alcoholic  extractive,  and  residue 
nitrogen. 

When  500  cc.  of  water  were  taken  with  meals  no  significant  changes  in 
protein  utilization  could  be  observed,  as  there  were  in  fat  and  carbohy- 
drate; the  protein  data  do,  however,  admit  of  the  negative  conclusion, 
that  absolutely  no  undesirable  effects  were  to  be  observed  as  a  result  of 
the  ingestion  of  500  cc.  of  water  with  the  meals.  Even  when  over  four 
liters  of  water  were  taken  daily,  with  the  meals,  there  was  no  indication 
of  untoward  effects  as  a  result. 

As  before,  the  beneficial  results  of  water  ingestion  with  meals  were 
not  transitory,  but  were  more  or  less  permanent,  extending  beyond  the 
time  of  the  experimental  period. 

REFERENCES. 

i.  Bischoff  and  Voit,  "Die  Ernahrung  des  Fleischfressers,"  p.  291.  2.  Voit,  "Bei- 
trage  zur  Frage  der  Sekretion  und  Resorption  im  Diinndarm,"  Z.  Biol.,  29,  325- 
97  (1892).  3.  Prausnitz,  "Die  Chemische  Zusammensetzung  des  Kotes  bei  ver- 
schiedenartiger  Ernahrung,"  Z.  Biol.,  35,  335-54  (1897).  4.  Schierbeck,  "Die  chem- 
ische  Zusammensetzung  des  Kotes  bei  verschiedener  Nahrung,"  Arch.  Hyg.,  51, 
62-5  (1904).  5.  Rubner,  Z.  BioL,  15,  115  (1879).  6.  Strasburger,  " Baktereinmenge 
in  menschlichen  Faces,"  Z.  klin.  Med.,  46,  413-44  (1902).  7.  MacNeal,  Latzer  and 
Kerr,  "The  Fecal  Bacteria  of  Healthy  Men,"  /.  Inf.  Dis.,  6,  123-69  (1909).  8. 
Mattill  and  Hawk,  /.  Exp.  Med.,  14,  433  (1911).  9.  Schottelius,  Arch.  Hyg.,  34, 
210  (1898);  Ibid.,  42,  48  (1902).  10.  Nuttall  and  Thierfelder,  Z.  physiol.  Chem., 
21,  109  (1895);  Ibid',  22,  62  (1896).  n.  Schottelius,  Arch.  Hyg.,  67,  177-208  (1908). 
12.  Ruzicka,  Arch.  Hyg.,  45,  409-16  (1902).  13.  Fowler  and  Hawk,  /.  Exp.  Med., 
12,  388-410  (1910).  14.  Zaitschek,  "Methodik  der  Bestimmung  des  Stickstoff-  und 
Eiweiss-  gehaltes  der  Faces,"  Arch.  ges.  Physiol.  (Pfliiger),  98,  595-613  (1903).  140. 
Emmett  and  Grindley,  Jour.  Am.  Chem.  Soc.,  31,  569  (1909).  146.  Howe,  Rutherford  and 
Hawk,  Jour.  Am.  Chem.  Soc.,  32,  1683  (1910).  15.  London  and  Pevsner,  Z.  physiol.  Chem., 
56,  384-7  (1908).  16.  Cohnheim,  Munch,  med.  Wochschr.,  54,  2851  (1907).  17.  Lon- 
don and  Polo  vzova,  Z.  physiol.  Chem.,  49,  328-96  (1906).  18.  Id.,  Ibid.,  57,  113-30 
(1908).  19.  Zunz,  Beitr.  chem.  Physiol.  u.  Path.,  3,  339  (1903).  20.  Carrel,  Meyer 
and  Levene,  Am.  J.  Physiol.,  25,  439-55  (1910).  21.  London  and  Dmitriev,  Z. 
physiol.  Chem.,  65,  213-18  (1910).  22.  Underhill,  Am.  J.  Physiol.,  27,  366-82  (1911). 

23.  Axhausen,  Grenzgeb.  Med.  Chir.,  21,  55  (1910);  through  Biochem.  Centr.,  9,  639. 

24.  Carrel,  Meyer  and  Levene,  Am.  J.  Physiol.,  26,  369-79  (1910).     25.  Zunz,  Mem. 
couronn.  et  autr.  mem.  publ.  par  I'Acad.  roy  de  medec.  de  belgique,  20,  fasc.  i ;  through 
Tahresb.  TiercJiem.,  38,  407  (1908). 


STUDIES  ON  WATER  DRINKING:     X.    FECAL  OUTPUT  AND  ITS 

CARBOHYDRATE  CONTENT  UNDER  THE  INFLUENCE  OF 

COPIOUS  AND  MODERATE  WATER  DRINKING 

WITH  MEALS. 

BY  H.  A.  MATTILL. 

Introduction. 

It  has  been  said  that  the  amount  of  feces,  as  well  as  its  nitrogen  content, 
depends  entirely  upon  the  cellulose  content  of  the  food  materials,  the 
first  being  the  result  of  the  inability  of  the  organism  to  digest  cellulose, 
the  second  being  due  to  the  increased  desquamation  of  intestinal 
epithelium  as  a  result  of  heightened  peristalsis  and  to  an  accompanying 
increase  in  the  amount  of  digestive  fluids  secreted. 

Aside  from  possible  traces  of  the  less  common  complex  carbohydrates, 
the  only  carbohydrates  ever  present  in  normal  feces  under  ordinary 
conditions  are  cellulose  and  starch.  It  has  been  shown  by  Lusk1  that  the 
decomposition  of  cellulose  does  not  result  in  the  formation  of  glucose, 
and  its  nutritive  value  is  probably  in  the  fatty  acids  formed  from  it. 
In  a  study  of  the  digestibility  of  carbohydrate,  therefore,  a  consideration 
of  the  possible  digestion  of  cellulose  is  unnecessary. 

The  source  of  starch  in  the  feces  is  ingested  vegetable  food,  the  cellulose 
envelopes  of  which,  as  a  result  of  insufficient  disintegration,  have  not 
become  accessible  to  the  action  of  the  digestive  juices.  The  manner  of 
preparing  the  food  has  much  to  do  with  the  extent  of  this  disintegration ; 
the  efficiency  of  the  mastication  also  plays  a  part,  and  the  activity  of  the 
digestive  juices  and  the  extent  of  the  churning  to  which  the  food  is  sub- 
jected in  the  intestin  also  have  an  influence.  All  other  conditions  re- 
maining the  same,  the  amount  of  carbohydrate  found  in  the  feces  should 
furnish  some  indication  as  to  the  digestibility  of  carbohydrate  in  the 
organism,  as  well  as  to  the  extent  of  cellular  disintegration  by  which 
it  has  become  available.  In  the  series  of  observations  reported  in  the 
preceding  papers  on  the  utilization  of  protein  and  fat  under  the  conditions 
of  water  drinking  with  meals  attention  was  also  paid  to  the  comparative 
amounts  of  fecal  dry  matter  and  moisture,  and  to  the  utilization  of  carbo- 
hydrate, although  the  diet  consisted  of  almost  completely  available  food 
and  contained  little  cellulose. 

The  early  experiment  of  Ruzicka2  previously  referred  to  included  certain 
data  upon  total  fecal  excretion.  During  the  first  2 -day  period  (no  water 
with  meals)  the  total  fecal  dry  matter  was  46.2  grams  against  42.0  grams 


44  STUDIES  ON  WATER  DRINKING.      X. 

in  the  second  2-day  period  when  water  was  taken  with  meals.  The 
total  dry  matter  ingested  during  the  first  (no  water)  period  was  783.3 
grams,  while  the  dry  matter  ingested  in  the  second  period  was  842.5 
grams.  The  carbohydrate  intake  and  excretion  (obtained  by  difference) 
for  the  two  periods  were  as  follows: 


period  Second  period 

(no  water).  (water). 

Grams.  Grams. 

Ingesta  ................     357.4  384.4 

Excreta  ................         6.9  6.3 

It  is  thus  seen  that  the  ingestion  both  of  total  dry  matter  and  of  carbo- 
hydrate was  larger  in  the  water  period  than  in  the  period  when  no  water 
was  taken  with  the  meals,  while  the  excretion  both  of  total  dry  matter 
and  of  carbohydrate  was  smaller  when  water  was  taken  with  meals  than 
when  none  was  taken.  The  diet  was  one  of  bread  and  meat,  and  analyses 
are  given  which  show  that  the  feces  were  of  relatively  the  same  com- 
position in  both  periods,  100  grams  of  the  dry  substance  yielding  14.9 
and  15.0  grams,  respectively,  of  carbohydrate. 

In  the  investigation  of  Fowler  and  Hawk3  referred  to  in  the  previous 
paper  the  elimination  of  fecal  dry  matter  and  moisture  during  the  period 
of  water  ingestion  with  meals  was  much  less  than  during  either  the  fore 
or  after  period.  No  data  were  obtained  on  carbohydrate  utilization. 

Methods.  —  In  the  paper  on  fat  utilization  will  be  found  a  description 
of  the  method  of  collecting  and  preparing  the  sample.  Moisture.  Mois- 
ture was  determined,  during  one  experiment,  in  porcelain  crucibles, 
during  a  second  in  lead  caps.  The  latter  method  is  much  more  satis- 
factory. The  samples  were  first  air-dried  for  two  or  three  days,  and  then 
in  an  oven  at  102°,  for  two  or  three  days. 

Carbohydrate.  —  Carbohydrate  was  determined  by  a  modification  of  the 
method  of  Strasburger.  4  The  procedure  was  as  follows:  Five  to  10 
grams  of  feces  were  weighed  out  into  a  200  cc.  Erlenmeyer  flask,  and  5-7 
grams  of  bone-black  were  added  along  with  100  cc.  of  2  per  cent,  hydro- 
chloric acid.  This  mixture  was  boiled  for  one  and  one-half  to  two  hours 
under  a  reflux  condenser,  allowed  to  cool,  made  alkaline  with  sodium 
hydroxide  to  precipitate  calcium  salts  and  filtered  with  suction. 
Ordinarily  this  took  considerable  time.  The  filtrate  was  clear  and  varied 
in  color  from  a  dark  straw  to  entire  absence  of  color.  This  solution  was 
approximately  neutralized  and  its  reducing  power  was  determined  in  an 
aliquot  portion  by  the  method  of  Benedict.6  The  procedure  of  Stras- 
burger involves  the  determination  of  sugar  by  the  copper  thiocyanate 
method  of  Volhard-Pfliiger,  and  the  time  and  labor  required  in  this  method 


STUDIES   ON   WATER  DRINKING.      X.  45 

are  considerably  greater  than  for  the  method  used  in  these  experiments. 
In  most  cases,  also,  satisfactory  duplicates  were  obtained.  The  solu- 
tions as  prepared  for  the  determination  could  never  be  allowed  to  stand 
any  length  of  time  with  neutral  or  slightly  alkaline  reaction  as  the  de- 
velopment of  molds  brought  about  decompositions  and  destruction  of 
sugar.  When  they  were  left  standing  they  were  always  acidified. 

Experiments  on  Copious  Water  Drinking  with  Meals. 

The  routine  of  the  experiment  on  Subjects  H  and  W  has  been  de- 
scribed in  a  preceding  paper.  The  diet  of  both  men  contained  carbohy- 
drate as  follows: 

Amount  (per  meal).  Carbohydrate. 

Graham  crackers 150  .o  grams  108 . 8  grams 

Peanut  butter 20.0  3.2 

Milk 450.0  (cc.)  25 .7 

Butter  (carbohydrate  negligible) 25.0 

Total,     137.7 
For  water  ingestion  see  paper  on  fat  utilization. 

Discussion  of  Data  from  Subject  W,  Table  I. — The  average  amount  of 
feces  passed  per  day  during  the  preliminary  period  was  177.8  grams, 
during  the  water  period  119.3  grams,  and  during  the  final  period  121.1 

TABLE  I. — SUBJECT  W. 


Prel.  period.     3  days 


Total 533.5  138.1  395-4  7-5^5 

Average  (per  day) 177.8  25.9  46.0  131.8  2.52 

5 214.0  13.17  28.2  185.8  2.09 

6 25.2  23.24  5.9  19.3  0.26 


Number 
of 
stool. 

j 

Weight. 
Grams. 

14.7  O 

Per  cent, 
dry 
matter. 

27   W 

Amount 
dry 
matter. 
Grams. 

4.0  2 

Amount 
moisture. 
Grams. 

106.8 

Car. 

drate 
Grams. 

I  -QSS 

2 

182  >; 

2*  86 

4.7    2 

I?C      -1 

2  .71 

66.0 

27  .  21 

18.0 

4.8.O 

1.  12 

4 

1^8  o 

27    6? 

^2    7 

IOS  ."? 

1.78 

Water  period.  5  days 


7 94-0  27.34  25.7  68.3  1.51 

8 102.8  28.85  29-7  73-1  I-S6 

9 121.5  26.05  3i-6  89.9  1.87 

10 39.0  29.83  n. 6  27.4  0.47 


Total 596.5  ...  132.7         463.8         7.76 

Average  (per  day) 119 .3         22.2  26.5  92.8         1.55 

ii 104.5         25.48  26.6          77.9         1.40 


Final  period.    3  days 


12 134.0        25.83  34-6          99-4        2.09 

13 26.9         31.85  8.6  18.3        0.38 

14 98.0        26.10          25.6          72.4         1.55 


Total 363.4  95-4         268.0        5.42 

Average  (per  day) 121.1         26.3  31-8  89.3         1.81 


46  STUDIES  ON  WATER  DRINKING.      X. 

grams.  A  similar  variation  is  observed  in  the  fecal  dry  matter  which  de- 
creases from  46  grams  per  day  in  the  preliminary  to  26.5  grams  in  the  water 
period  and  again  rizes  in  the  final  to  31.8  grams.  The  average  daily 
amount  of  water  in  the  feces  of  the  preliminary  period  was  131.8  grams, 
in  the  water  period  92.8  grams  and  in  the  final  period  89.3  grams.  Not- 
withstanding the  large  amount  of  water  passed  into  the  intestin  during 
the  water  period,  there  was  less  in  the  feces  during  that  time  than  before; 
the  amount  of  water  excreted  in  the  feces  in  the  final  period  was  slightly 
less  than  the  amount  in  the  water  period.  The  total  amount  of  feces 
and  of  dry  matter  for  the  final  period  were  only  slightly  higher  than 
those  of  the  water  period  and  not  nearly  as  high  as  those  of  the  prelim- 
inary. 

Digestion  and  Absorption  of  Carbohydrate. — The  average  daily  excre- 
tion of  carbohydrate  during  the  preliminary  period  was  2.52  grams, 
during  the  water  period  1.55  grams,  and  during  the  final  period  1.81 
grams.  It  appears  that  the  effect  of  the  large  amount  of  water  was  to 
secure  a  better  digestion  and  more  complete  utilization  of  the  ingested 
carbohydrate,  and  the  influence  of  the  water  extended  beyond  the  time 
in  which  it  was  used. 

The  amount  of  carbohydrate  in  Stool  No.  5,  the  first  of  the  water 
period  is  2.09  grams,  the  largest  amount  during  any  day  of  the  period. 
This  is  the  more  striking  since  the  entire  stool  contained  only  28.2  grams 
solid  matter,  of  which  5.8  grams  were  fat.  The  total  nitrogen  was  also 
above  the  average,  and  the  bacterial  and  extractive  or  acid-alcohol- 
soluble  portions  were  unusually  low.  All  of  these  facts  indicate  in- 
complete digestion  of  the  food.  Stool  No.  5  was  passed  immediately 
after  breakfast  on  the  morning  of  the  second  day  of  water.  Before 
breakfast  Stool  No.  4  had  been  passed;  this  contained  none  of  the  char- 
coal that  had  been  taken  before  breakfast  on  the  morning  of  the  day 
before,  the  first  day  of  the  water.  Charcoal  was  found  in  No.  5.  W 
records  a  feeling  of  pressure  on  the  first  day  of  water  as  well  as  on  the 
second,  but  on  the  second  it  seemed  to  increase.  Stool  No.  5  gives  evi- 
dence from  its  high  content  of  water  and  of  foodstuffs  that  it  was  forced 
out  before  the  time  necessary  for  satisfactory  digestion  and  absorption. 
Notwithstanding  that  this,  the  first  stool  of  the  water  period  contained 
undigested  protein,  fat  and  carbohydrate,  nevertheless  an  examination 
of  the  data  shows  that  the  average  daily  output  of  those  substances  was 
markedly  lowered  under  the  influence  of  water  ingestion. 

Discussion  of  Data  from  Subject  H,  Table  II. — The  average  daily  amount 
of  feces  passed  during  the  water  period  was  less  than  that  in  either  pre- 
liminary or  final  periods.  The  average  amount  in  the  period  after  the 
water  is  less  than  that  in  the  period  before  the  water.  The  average  daily 
dry  matter  suffered  a  similar  drop  during  the  water  period.  The  amount 


STUDIES   ON   WATER   DRINKING.      X. 


47 


of  water  in  the  feces  during  the  water  period  was  also  less  than  during  the 
preliminary  or  final  periods  showing  that  even  with  the  large  amounts 
of  water  sent  into  the  intestin  the  amount  absorbed  was  actually  more 
than  the  excess  administered. 


TABLE  II. — SUBJECT  H. 


Number 
of  stool. 


Weight. 
Grams. 


Prel.  period.     3  days  < 


1 42.5 

2 87.0 

3 158.0 

4 104.0 


Per  cent. 

dry 
matter. 

29.42 
26.54 
26.57 
26.21 


Amount  Car- 
dry  Amount  bohy- 
matter.  moisture.  drate. 
Grams.  Grams.  Grams. 


Average  (per  day). 

oy*  '3 
I-JQ    5 

26  8 

CA.O 

17    71 

6     . 

8l    7 

27    OS 

Water  period  5  days  • 

A*!    Q 

31  68 

8  

26Q.  S 

24.    fl 

141  o 

22   OO 

Total      

580.2 

Average  (per  dav) 

117.  8 

24..  2 

10  

....       IOI  .O 

27.QO 

ii 

2C    c 

•j-7    4.0 

Final  period.    3  days  • 

12 

112    O 

27    QO 

I  -I.  . 

I4.I  .  5 

25  ,Q2 

Total 

380  o 

Averaee  Coer  dav). 

126.7 

26.2 

12-5 

30.0 

0-57 

23.1 

63-9 

1.20 

42.0 

116.0 

2.37 

27-3 

76.7 

1.  80 

104.9 

286.6 

5-94 

35-0 

95-5 

1.98 

9.6 

44.4 

0.66 

22.8 

58.9 

1-45 

13-6 

29.4 

0.82 

65.6 

203.9 

3-89 

31.0 

IIO.O 

1.87 

142.6 

446.6 

8.69 

28.5 

89.3 

1.74 

24.1 

76.9 

i.  06 

8-5 

17.0 

0-37 

31-3 

80.7 

1.71 

36.7 

104.8 

1.92 

100.6 

279.4 

5.06 

33-5 

93-1 

1.69 

Carbohydrate. — The  data  from  the  carbohydrate  determinations  are 
not  as  striking  as  those  from  Subject  W  but  the  variations  are  in  the  same 
direction.  The  average  daily  excretion  during  the  preliminary  period,  i  .98 
grams,  fell  to  1.74  grams  during  the  water  period,  and  was  still  less,  1.69 
grams  per  day,  in  the  final  period. 

Summary. — The  findings  obtained  in  this  experiment  show  that  during 
the  period  when  large  amounts  of  water  were  taken  with  meals  the  total 
amounts  of  feces,  of  fecal  dry  matter  and  of  fecal  moisture  were  less  than 
without  the  unusual  amounts  of  water,  and  that  a  more  or  less  permanently 
better  utilization  of  carbohydrate  accompanied  the  water  drinking. 

Experiments  on  Moderate  Water  Drinking. 

Before  considering  the  data  obtained  in  the  experiment  on  moderate 
water  drinking  a  word  of  explanation  should  be  given  regarding  Sub- 


48  STUDIES  ON   WATER   DRINKING.      X. 

ject  E.  During  the  preceding  year  while  he  was  serving  as  subject  on 
another  metabolism  experiment  and  was  on  a  uniform  diet  a  pronounced 
intestinal  fermentation  made  itself  evident  by  a  stool  of  high  moisture 
content.  Although  he  was  subject  to  a  condition  of  this  kind  even  on  an 
ordinary  mixed  diet  he  made  no  mention  of  this  and  was  therefore  accepted 
for  the  present  metabolism  study.  The  condition  was  one  apparently 
peculiar  to  the  organism  and  was  not  dependent  upon  such  external 
conditions  as  could  easily  be  determined  and  controlled.  Subject  W 
had  served  in  the  preceding  experiment. 

The  diets  of  the  two  men  were  alike  in  composition  but  differed  slightly 
in  quantity. 

SUBJECT  W. 

Amount 
(per  meal).  Carbohydrate. 

Graham  crackers 125  grams  90.6  grams 

Peanut  butter 20  3.2 

Milk 400  (cc.)  22.8 

Butter  (carbohydrate  negligible) 25 

Total,  116.6 
SUBJECT  E. 

Amount.  Carbohydrate. 

Graham  crackers 150  grams  108 . 8  grams 

Peanut  butter 20  3.2 

Milk 400  (cc.)  22.8 

Butter  (carbohydrate  negligible) 25 

Total,     134.8 
For  water  ingestion  see  paper  on  fat  utilization. 

In  addition  to  the  weights  of  feces,  dry  matter  and  moisture,  the  values 
for  the  daily  excretion  of  dry  bacteria  are  also  given ;  the  values  have  been 
calculated  from  the  bacterial  nitrogen  values  on  the  basis  of  a  nitrogen 
content  of  dry  bacteria  equal  to  10.96  per  cent.;  this  is  more  fully  ex- 
plained by  us  in  a  recent  paper  on  the  method  for  determining  bacterial 
nitrogen.* 

Discussion  of  Data  from  Subject  W,  Table  III. — The  separation  of  the 
preliminary  period  of  low  water  ingestion  into  two  parts  showed  a  con- 
dition for  carbohydrate  and  for  total  fecal  output  similar  to  that  noted 
for  fat  and  protein.  The  average  amount  of  feces  passed  per  day  during 
the  first  part  of  this  period  was  89.0  grams,  as  against  104.6  grams  in  the 
second.  The  average  daily  dry  matter  content  during  the  first  part  of 
this  period  was  23.9  grams  as  against  27.3  grams  during  the  second  part. 
The  differences  are  small  but  not  inconsiderable.  Carbohydrate  also 
shows  an  increase  from  2.15  grams  per  day  in  the  first  part  to  2.31  grams 
in  the  second.  Comparing  this  preliminary  period  with  that  of  the  first 
experiment,  the  average  daily  amount  of  feces  in  the  first  experiment  was 
*  Mattill  and  Hawk:  J.  Exp.  Med.,  14,  433  (1911). 


STUDIES   ON    WATER   DRINKING.      X. 


49 


TABLE  III. — SUBJECT  W. 


Number 
of  stool. 


Amount 
Per  cent,      dry 
Weight.       dry       matter. 
Grams,    matter     Grams. 


Prel.  period  I.    7  days  ' 


155-5 
39-2 
63-7 
72.0 

201.8 

90.9 


Total 623 .  i 


Average  (per  day) . 


Prel.  period  II.   6  days 


7- 
8. 

9- 
10. 
n. 

12. 
13- 


89.0 

62.8 

98.8 

109.8 

185.8 

41.8 

104.9 


25.94 
31-57 
27.78 
28.92 
27.04 
23-50 


26.85 
25.61 
26.72 

27.50 

24.10 

31.23 
24.28 


40-3 
12.4 
17.7 
20.8 

54.6 
21.4 

167.2 

23.9 

16.1 
26.4 
30-2 
44-8 
i3-i 
25.5 


24.0    32.87         7.9 


Total 627.9 

Average  (per  day) 104.6 

31-6 
H7.5 


Water  period .    10  days 


15- 

16. 

17- 
18. 
19. 
20. 

21. 

22. 
23- 


75-4 
144.8 

63-9 
ii5-5 

26.0 
169.0 
127.0 
152-7 


26.10 

23.90 

27.52 

26.20 

27.45 
26.84 

27.10 

27.49 
26.52 

24.35 

23.26 


164.0 
27-3 
7-6 
40.6 
19.8 
39-8 
17.2 

31-3 
7.2 

44.8 
30.9 
35-5 


Total 1053.4 


Bacterial       Car- 
Amount          dry  bohy- 
moisture.  substance,    drate 
Grams.       Grams.      Grams. 


115.2 
26.8 
46.0 
51-2 

147.2 

69.5 


455-9 
65.1 
46.7 
72.4 
79.6 

141.0 
28.7 
79-4 
16.1 

463.9 
77-3 
24.0 

106.9 
55.6 

105.0 
46.7 
84.2 
18.8 

124.2 
96.1 

117.2 


4.40 
6.32 
7.21 
10.10 
2.62 
5.38 
1.78 

37.80 
6.30 
1.82 
8.98 

5.13 
9.92 
4.02 

7-97 
1.81 
11.84 
8.04 
9.08 


26. 


1.14 
1.92 
1.89 

5-22 
1.74 

I5-07 
2-15 
1-52 
2.08 
3.05 
3.58 
1.03 
2.15 
0.45 

13-86 

2.31 
0.25 
2.25 


20 

60 

37 


2-51 
0.56 
4.60 
2-93 
3-54 


274.7         778.7       68.60       21.81 


Average  (per  day) 105.3     26.12       27.5  77.8         6.86         2.18 


Final  period.     5  days  < 


Total 508.2 

Average  (per  day) 101 .6     25 .90 

177.8  grams  as  against  89.0  in  the  second;  dry  matter  46.0  grams  in  the 
first  as  against  23.9  in  the  second;  carbohydrate  2.52  grams  in  the  first 
as  against  2.15  in  the  second. 

Carbohydrate. — An  examination  of  the  data  upon  carbohydrate  excre- 


STUDIES  ON  WATER  DRINKING.      X. 


tion  during  the  ten-day  water  period  reveals  differences  that  are  small 
but  nevertheless  in  the  same  direction  as  noted  in  the  experiment  on 
copious  water  drinking.  The  daily  average  excretion  in  the  preliminary 
period,  2.31  grams,  fell  to  2.18  grams  in  the  water  period,  and  was  still 
lower,  to  2.07  grams,  in  the  final  period. 

Discussion  of  Data  from  Subject  E,  Table  IV. — The  findings  upon  the 
fecal  output  of  Subject  E  during  the  three  periods  of  this  experiment 
show  variations  so  small  that  they  admit  of  no  conclusions. 

TABLE  IV. — SUBJECT  E. 


] 

Dumber 
of 
stool. 

I  

2  

] 
Weight. 

Grams. 

88.4 
1O    2 

Jer  cent, 
dry 
matter. 

20.  8l 
26.56 

7    . 

I7Q    2 

27    OI 

TQ7     Q 

24.    67 

Prel.  period.     7  days  ' 

c    . 

76  o 

26    17 

6     .    . 

2O7    7 

22    78 

124  6 

22    3O 

8   

4-4-   O 

20   4.2 

Total 

Q4.4.   O 

Average  (per  dav) 

21    7O 

76  c. 

22    87 

9. 
10 

I4.O   Q 

20    88 

ii  

63  8 

20.  16 

12       .     . 

1  60  o 

24.    1O 

11 

24.7    ^ 

IQ    IQ 

Water  period.  lodays' 

14..  . 

ITS    V 

22  .06 

15  
16 

192.4 
7Q    2 

I9.58 

24.    ^8 

CC      Q 

27  .  17 

18 

17-7    c 

24.   QI 

IQ.  . 

27  .08 

Total  

Average  (per  day) 



1385.5 

118  6 

22    T\ 

2O  
21     .... 

67.3 

117.  8 

23.60 
26.08 

Final  period      4  days  • 

22 

14.7    7 

27     IQ 

23  
24.    . 

145-9 
^1  .  2 

26-49 
71      CC 

Total  

SOQ  .Q 

Averaee  (oer  dav}  .  . 

127.5 

2^.74. 

18.4 

70.0 

2.48 

8.0 

22.2 

.  .  . 

1.18 

41.2 

138.0 

4-98 

47.8 

146.1 

.  .  . 

7.21 

20.1 

56.8 

2-37 

47-3 

160.4 

5-31 

27.8 

96.8 

3.49 

12.9 

3I-I 

1.38 

223.7 

721.2 

28.40 

32.0 

103.0 

4.06 

17-5 

59-o 

4.89 

2.48 

29.4 

111.5 

9.90 

4-47 

18.6 

45-2 

6.25 

i-55 

41.1 

127.9 

12.52 

4.04 

47-5 

200.  o 

13-17 

4.80 

3I-I 

104.2 

9-29 

3-33 

37-7 

154-7 

9.88 

4.18 

19-5 

59-7 

4-77 

i-33 

15-2 

40.7 

3-88 

1.48 

43-2 

130.3 

12.25 

3-68 

14.4 

37-i 

4.06 

1.17 

315-2 

1070.3 

90.85 

32-51 

3i-5 

107.  i 

9.09 

3-25 

15-9 

5i-4 

3.88 

1.42 

30.7 

87.1 

9.26 

2.76 

34-3 

II3-4 

9-74 

3.46 

38.7 

106.2 

11-34 

4-53 

9.8 

21.4 

1.78 

0.81 

129.4 

380.5 

36.0 

12.98 

32.3 

95-2 

9.0 

3-25 

Carbohydrate. — The  average  daily  excretion  of  carbohydrate  dropped 
from  4.06  grams  to  3.25  grams  during  the  water  period,  and  stayed  at 


STUDIES  ON   WATER  DRINKING.      X. 


the  same  value  in  the  final.  This  is  a  small  difference  to  be  significant 
but  on  a  uniform  diet  the  evidence  is  creditable;  it  points  to  the  same 
conclusion  for  moderate  water  drinking  that  has  been  reached  up  to  this 
time  for  copious  water  drinking. 

On  the  basis  of  these  data  it  appears  that  the  effect  of  a  moderate 
amount  of  water  with  meals  is  in  the  same  direction  as  when  large  amounts 
are  used,  although  the  differences  observed  are  much  smaller  and  not  as 
uniformly  found  as  with  the  copious  amounts  of  water.  Absolutely 
no  harmful  results  could  be  detected. 

Copious  Water  Drinking  by  an  Habitual  Water  Drinker. 

The  experiment  of  14  days,  during  the  5 -day  water  period  of  which 
Subject  E  took  1333  cc.  of  water  additional  with  each  meal,  remains  to 
be  considered. 

TABI,E  V. — SUBJECT  E. 

Amount  Bacterial      Car- 

Amount  dry  bohy 

moisture,  substance,    drate 
Grams.       Grams.     Grams. 


M 
c 

Prel.  period.     6  days  « 
Total 

umber 
f  stool. 

I 

Per  cent. 
Weight.       dry 
Grams,   matter. 

35.2      28.88 
66.0     28.48 
202.2       24.65 
129.2       24.89 
I6I.3      21.43 
I7I.8      22.  6l 
34.6      27.24 

dry 
matter. 
Grams. 

IO.2 

18.8 
49.8 
32.2 
34-6 
38.8 
9-4 

2 

•7 

4  

e 

6       ... 

800.3 
133.4 
90.3 

37-2 
249.4 

74-7 
258.0 
52.6 

24.21 

20.15 
27-33 
23.57 
26.57 
14.81 
30.23 

193.8 
32.3 
18.2 

IO.2 

58.8 
19.9 
38.2 
15.9 

Average  (per  day)  .  - 

Water  period.  5  days 
Total 

g 

9.  . 
10  .    .    .    . 

1  1 

12  

T-I 

762.2 
152.5 

128.3 
86.4 
206.5 
50.6 

21  .  12 

23.09 

24-34 
21.56 
II  .06 

161  .  i 
32.2 
29.6 

21.0 

44-5 
5-6 

Average  (per  day)  .  . 

Final  period.    3  days 

Total  
Average  (per  day)  . 

14. 

je 

16 

17.  . 

471.8 
tin.  a 

2  I  .  36 

100.8 
33.6 

25.0 

47.2 

152.4 

97.0 

126.7 

133.0 
25.2 


2.80 

6.32 

15.64 

9.92 

10.99 

11.54 
3.32 


1.02 
2.03 
5-59 
3.17 
3-73 
4-43 
0.97 


606.5          60.52          20.94 


3-49 


loi.i       10.09 


72.1 

27.0 

I9O.6 

54-8 

219.8 

36.7 


5-83 
3-33 
18.61 
6.01 
9.86 
4.81 


2.14 
i. 06 
7.72 
1.52 
6.42 
1.23 


60I.I          48.47          20.12 


120.2 

98.7 

65.4 

162.0 

45-o 

371.0 
123-7 


9.69 

9.50 

7.00 

14.19 

1-45 

32.14 
10.72 


4.02 

3-07 

1-51 
3.06 

0-43 

8.07 
2.69 


Discussion  of  Data  from  Subject  E,  Table  V. — An  examination  of  the 
data  in  Table  V  shows  that  the  average  amount  of  feces  excreted  per  day 
was  133.4  grams  during  the  preliminary  period,  152.5  grams  during  the 


52  STUDIES  ON  WATER  DRINKING.      X. 

water  period,  and  157.3  grams  in  the  final  period.  Tkis  marked  increase 
during  the  water  and  final  periods  is  not  evident  from  the  values  for  dry 
matter.  During  the  preliminary  period  this  averaged  32.3  grams  per 
day,  during  the  water  period  32.2  grams  per  day,  and  during  the  final 
33-6  grams  per  day,  values  which  are  strikingly  uniform. 

The  apparent  increase  in  the  average  daily  amount  of  feces  was  thus 
due  to  water  only,  and  it  would  seem  that  the  absorption  limit  of  water 
in  the  intestin  had  been  reached.  While  no  difficulty  was  experienced 
in  drinking  the  large  volume  of  water,  the  limit  for  its  absorption  had 
been  passed.  In  the  case  of  Subject  W  in  the  first  experiment  there  was 
no  evidence  of  having  reached  the  absorption  limit,  while  some  difficulty 
was  at  first  experienced  hi  ingesting  and  disposing  of  the  large  quantity 
of  water.  This  would  lead  to  the  conclusion  that  individuality  and 
dietary  habit  are  important  factors. 

Carbohydrate. — The  average  daily  excretion  of  carbohydrate  rose  from 
3.49  in  the  preliminary  period  to  4.02  in  the  water  period,  and  fell  to 
2.69  in  the  final  period.  Stool  No.  12  weighing  258  grams  contained 
6.42  grams  of  carbohydrate  and  only  38.2  grams  of  solid  matter;  there 
was  pronounced  evidence  of  fermentation.  It  was  passed  15  hours 
before  the  usual  time  and  was  evidently  the  result  of  the  intestinal  con- 
ditions previously  mentioned,  to  which  B  was  subject  at  times.  A  larger 
amount  of  undigested  material  than  was  usual  might  therefore  be  ex- 
pected, and  its  appearance  could  not  be  attributed  to  the  effect  of  the 
water.  The  fall  in  excreted  carbohydrate  during  the  final  period  is 
marked,  and  shows  rather  conclusively  that  the  high  daily  average  out- 
put during  the  water  period  was  not  due  to  the  fact  that  water  inter- 
fered with  the  digestion  of  ingested  carbohydrate  but  rather  that  the 
unusual  finding  during  the  water  period  may  logically  be  explained  as 
above. 

Discussion. 

The  findings  of  decreased  fecal  output,  both  dry  matter  and  moisture, 
and  a  decreased  elimination  of  carbohydrate  during  the  periods  of  water 
drinking  indicate  a  more  complete  absorption  of  both  water  and  dis- 
solved material,  with  the  exceptions  noted  above.  It  has  been  seen,  in 
the  preceding  papers,  that  this  decreased  excretion  of  solid  matter  was 
the  result  also  of  a  better  utilization  of  the  nitrogen  (protein)  and  fat 
of  the  diet. 

If  drinking  water  with  meals  brought  about  a  more  rapid  emptying  of 
the  stomach,  the  carbohydrates  might  reasonably  be  expected  to  give 
the  first  evidence  of  this  fact  because  of  all  the  foodstuffs  carbohydrates 
are  normally  the  first  to  leave  the  stomach  and  a  shortening  of  the  time 
of  their  sojourn  there  might  mean  incomplete  hydrolysis  of  starch  by 
salivary  amylase.  In  experiments  on  dogs  London  and  Polovzova6 


STUDIES  ON   WATER   DRINKING.      X.  53 

have  shown  that  sucrose  and  erythrodextrin  alone  suffer  a  slight  hy- 
drolysis in  the  stomach,  due  not  to  enzymes  but  to  hydrochloric  acid, 
and  that  under  no  conditions  are  carbohydrates  absorbed  in  the  stomach. 
In  the  duodenum  hydrolytic  cleavage  is  very  extensive  but  absorption 
does  not  begin  until  the  upper  ileum  is  reached  where  the  greater  portion 
of  carbohydrate  is  absorbed.  The  great  importance  of  the  duodenal 
juices  in  carbohydrate  digestion  is  hereby  emphasized. 

This  evidence  may  be  of  less  value  because  of  the  fact  that  the  saliva 
of  the  dog  has  at  most  but  a  slight  amylolytic  power.  8a>  66>  ** 

In  this  connection  it  should  also  be  noted  that  certain  experiments 
in  this  laboratory7  have  shown  that  the  production  of  pancreatic  amylase 
is  increased  under  the  influence  of  water  drinking,  as  would  be  supposed, 
and  this  fact  may  account  in  part,  for  the  better  utilization  of  carbo- 
hydrate. 

As  to  the  absorptive  activity  of  the  stomach  toward  carbohydrates, 
von  Mering8  concluded  from  some  of  his  observations  that  the  various 
sugars  could  be  absorbed  in  the  stomach,  absorption  being  dependent 
upon  the  concentration  of  the  solution;  that  below  5  per  cent,  glucose 
was  not  sensibly  absorbed. 

The  experiments  upon  the  absorption  of  carbohydrate  solutions  of 
different  concentrations  in  the  intestin  have  been  very  clear  in  showing 
the  acceleration  of  absorption  by  dilution.  In  experiments  on  dogs  with 
intestinal  fistulas  Kaoru  Omi9  has  found  that  in  the  absorption  of  solu- 
tions of  sodium  chloride  and  glucose  the  percentage  of  sodium  chloride  and 
glucose  absorbed  depends  on  the  concentration  of  the  solutions  introduced 
and  is  maximum  for  isotonic  solutions.  The  absorption  of  cane  sugar  is 
maximum  at  lower  than  isotonic  concentration.  The  amount  of  water 
absorbed  diminishes  with  increasing  concentration  of  the  solute  and  at 
slight  hypertonicity  absorption  is  checked. 

London  and  Polovzova10  have  made  similar  experiments  with  solu- 
tions of  glucose  on  dogs  with  intestinal  fistulas  and  the  following  are  their 
findings.  With  increasing  concentrations  of  the  glucose  solutions  intro- 
duced, absorption  of  water  in  the  intestin  diminishes  progressively. 
With  higher  concentrations  a  diluting  secretion  begins  to  flow  from  the 
wall  of  the  intestin;  its  amount  runs  parallel  with  increasing  concentra- 
tion of  the  glucose  solution,  and  at  its  maximum  it  may  amount  to  one- 
half  the  total  quantity  of  blood  in  the  animal.  By  this  dilution  and  also 
by  absorption  of  sugar  the  concentration  of  the  solution  is  brought  down 
to  6-8  per  cent.,  a  dilution  at  which  absorption  takes  place  very  readily 
in  the  lower  intestinal  tract.  The  secretion  of  the  diluting  fluid  begins 
with  the  coming  in  of  the  first  glucose  solution  and  continues  fairly  uni- 
formly. Dilute  glucose  solutions  seem  better  adapted  to  absorption  than 
concentrated  ones.  In  the  lower  portions  of  the  intestinal  tract  the  con- 


54  STUDIES  ON  WATER  DRINKING.       X. 

centration  tends  toward  a  value  that  is  lower  than  isotonic.  The  diluting 
secretion  has  a  small  amount  of  nitrogen  (o.i  per  cent.)  and  possesses  a 
kinase,  so  that  in  part  at  least  it  represents  an  increased  intestinal  secre- 
tion. For  concentrated  solutions  absorption  seems  to  take  place  in  two 
stages:  in  the  proximal  portion  of  the  intestin  the  proper  dilution  is 
reached,  in  the  distal  portion  absorption  takes  place.  The  intestinal 
wall  differs  from  the  stomach  wall  in  that  the  latter  does  not  dilute  con- 
centrated solutions.  The  absorption  of  water  and  of  dissolved  substances 
must  be  considered  as  two  independent  and  distinct  processes,  brought 
about  by  different  factors.  The  ability  to  regulate  automatically  the 
concentration  of  substances  to  be  absorbed  is  believed  to  be  a  part  of  the 
function  of  the  digestive  juices. 

Applying  these  findings  to  the  experiments  on  water  drinking  with 
meals  the  explanation  for  the  more  complete  digestion  and  absorption 
of  carbohydrates  during  the  period  of  water  ingestion  is  facilitated. 
Increased  dilution  is  the  effective  factor.  While  it  would  seem  in  these 
experiments  that  the  water  taken  with  a  given  meal  is  voided  in  the 
urine  before  the  bulk  of  the  food  material  of  that  meal  has  reached  the 
intestin,  nevertheless  some  of  the  food  must  be  carried  along  with  the 
water.  And  further,  since  absorption  is  going  on  more  or  less  contin- 
uously in  the  intestin,  the  water  taken  with  one  meal  aids  in  diluting  the 
products  of  the  previous  meal  which  are  in  the  intestin.  Not  only  is 
enzyme  action  more  complete  in  dilute  solutions  but  such  solutions  are 
also  better  adapted  to  absorption.  When  the  solutions  to  be  absorbed 
are  not  dilute  the  organism  must  first  make  them  so  by  pouring  out  a 
diluting  secretion;  if  they  have  been  made  dilute,  the  organism  is  spared 
this  task. 

It  has  been  shown  by  Mosenthal11  that  nitrogen  to  the  amount  of  about 
35  per  cent,  of  the  food  nitrogen  of  a  mixed  diet  is  daily  secreted  in  the 
succus  entericus  of  dogs,  and  that  of  this  quantity  an  amount  equal  to 
10  per  cent,  of  the  food  nitrogen  is  excreted  in  the  feces  and  an  amount 
equal  to  25  per  cent,  of  the  food  nitrogen  is  reabsorbed.  The  metabolic 
significance  of  this  reabsorption  is  not  understood,  but  it  is  probably  of 
great  importance.  In  cases  of  defective  absorption  the  amount  of  fecal 
nitrogen  may  easily  be  increased  from  this  source  and  thus  lead  to  the 
drawing  of  wrong  conclusions.  It  is  obvious  that  for  various  reasons, 
this  possibility  need  not  be  considered  in  connection  with  water  drinking. 

That  secretion  and  absorption  are  exothermic  in  their  nature  and  re- 
quire energy  has  frequently  been  shown  and  again  recently,12-  13  and  in 
their  first  report  of  observations  on  the  stimulating  action  of  water  upon 
the  gastric,  mucous  membrane,  Foster  and  Lambert14  suggest  that  a 
physiological  basis  for  the  objection  to  copious  water  drinking  with  meals 
may  be  found  in  the  increased  activity  to  which  the  glands  are  thus 


STUDIES   ON   WATER   DRINKING.      X.  55 

forced.  If  glandular  activity  requires  as  much  energy  as  other  forms  of 
activity,  this  special  and  excessive  secretion  may  be  a  form  of  extrav- 
agance leading  to  the  weakening  and  premature  death  of  the  cells.  In 
fact,  they  find  that  the  juice  excited  by  a  meal  following  5  or  6  hours 
after  a  meal  with  water  and  its  greater  demands  is  less  in  amount  than  a 
normal  meal  should  excite.  Whether  this  is  a  true  gland  fatigue,  and 
whether  or  not  such  observations  point  to  a  premature  death  of  the 
cells  can  be  determined  only  by  histological  examinations.1  Applying 
this  reasoning  to  the  secretory  activity  of  the  intestin  a  similar  form  of 
extravagance  may  be  said  to  be  caused  in  the  intestin  by  insufficient 
water  ingestion  with  meals.  If  there  is  a  loss  in  energy  in  the  increased 
flow  of  gastric  juice  by  water  drinking,  this  is  more  than  compensated 
by  better  digestion  and  absorption  of  food  in  the  intestin,  while  the 
needless  energy  used  in  preparing  a  diluting  secretion  for  food  which  is 
too  concentrated  is  a  direct  loss  uncompensated  by  any  subsequent 
factors  making  for  better  utilization  of  the  food.  The  preservation  of 
the  digestive  efficiency  of  the  intestin  is  probably  of  much  greater 
importance  than  that  of  the  stomach,  since  it  may  be  that  the  main 
offices  of  the  stomach  are  not  those  of  a  digestive  nature.15 

Conclusions. 

(1)  It  has  been  shown  that  in  men  living  on  a  uniform  diet  the  addi- 
tion of  1000  cc.  of  water  to  each  meal  causes  a  decrease  in  the  excretion 
of  fecal  material,  both  dry  matter  and  moisture. 

(2)  Under  the  same  conditions  a  decrease  in  excreted  carbohydrate 
material  was  also  observed. 

(3)  The  better  utilization  of  food  material  thus  evident  was  not  tem- 
porary but  appeared  to  extend  for  some  time  following  the  use  of  water. 

(4)  The  ingestion  of  a  smaller  amount  of  water  (500  cc.)  and  the  use 
of  a  large  volume  of  water  (1333  cc.)  by  one  accustomed  to  drinking  water 
with  meals  showed  a  similar  but  less  marked  reduction  in  the  excretion 
of  carbohydrate. 

(5)  The  individual  variations  noted  emphasize  the  fact  that  the  find- 
ings on  two  or  three  men  possessing  different  dietary  habits  and  accus- 
tomed to  ingesting  varying  volumes  of  water  with  meals  may  not  be 
generalized. 

(6)  The  beneficial  effects  noted  are  probably  due  to  the  stimulatory 
action  of  water  upon  the  digestive  secretions,  to  the  increased  dilution 
which  facilitates  enzyme  action  and  materially  aids  in  absorption,  and 
to  a  conservation  of  the  intestinal  energy  involved  in  the  secretion  of  a 
diluting  fluid  which  is  necessary  when  insufficient  water  is  ingested. 

(7)  The  average  daily  output  of  dry  bacterial  substance  for  the  66 
stools  completely  examined  was  8.27  grams. 

1  Investigations  of  this  character  are  contemplated. 


56  STUDIES  ON  WATER  DRINKING-      X. 

(8)  Many  desirable  and  no  undesirable  effects  were  obtained  by  the 
use  of  water  with  meals,  and  in  general,  the  more  water  taken  the  more 
pronounced  were  the  benefits. 

REFERENCES. 

i.  Lusk,  Am.  J.  Physiol.,  27,  467-8  (1911).  2.  Ruzicka,  Arch.  Hyg.,  45,  409-16 
(1902).  3.  Fowler  and  Hawk,  /.  Exp.  Med.,  12,  388-410  (1910).  4.  Strasburger, 
Die  Faces  des  Menschen,  p.  173.  5.  Benedict,  Jour.  Biol.  Chem.,  3,  101-17  (I9°7)-  6. 
London  and  Polovzova,  Z.  physiol.  Chem.,  56,  512-44  (1908).  6a.  Nielsen  and  Terry, 
Am.  J.  Physiol.,  15,  406  (1906).  66.  Mendel  and  Underbill,  /.  Biol.  Chem.,  3,  135 
(1907).  6c.  Garrey,  Proc.  Am.  Soc.  Biol.  Chem.,  July,  1907.  7.  Hawk,  Arch.  Int. 
Med.,  8,  382  (1911).  8.  von  Mering,  Therap.  Monats.,  7,  201-4  (1893).  9.  Kaoru 
Omi,  Arch.  ges.  Phys.  (Pfluger),  126,  428-52  (1909).  10.  London  and  Polovzova, 
Z.  physiol.  Chem.,  57,  529-46  (1907).  n.  Mosenthal,  Proc.  Soc.  Exp.  Biol.  Med.,  8, 
40  (1910).  12.  Brodie  and  Vogt,  /.  Physiol.,  40,  135-72  (1910).  13.  Brodie,  Cullis 
and  Halliburton,  Ibid.,  40,  173-89  (1910).  14.  Foster  and  Lambert,  /.  Exp.  Med., 
10,  820  (1908).  15.  Taylor,  Univ.  Penn.  Med.  Bull.,  22,  162-7  (J9O9)- 

The  author  desires  to  express  his  gratitude  to  Professor  Hawk  for  his 
many  suggestions  and  for  his  continued  and  valuable  assistance  in 
carrying  out  this  work. 


BIOGRAPHICAL. 

Henry  Albright  Mattill  graduated  from  Adelbert  College,  Western 
Reserve  University,  in  1906  with  the  degree  of  Bachelor  of  Arts,  magna 
cum  laude.  In  the  years  1906-8  he  was  Assistant  in  Chemistry  at  the 
University  of  Illinois,  the  first  year  in  Quantitative  and  Food  Analysis, 
the  second  in  General  Chemistry  and  Qualitative  Analysis.  In  1907,  after 
completing  the  required  work  he  received  in  absentia  the  degree  of  Master 
of  Arts  from  Western  Reserve  University.  In  the  years  1908-10  he  held 
a  fellowship  in  Physiological  Chemistry  in  the  University  of  Illinois,  pur- 
suing work  in  Physiological  Chemistry,  Physiology  and  Physical  Chemistry, 
leading  to  the  degree  of  Doctor  of  Philosophy.  He  was  Assistant  Pro- 
fessor of  Physiology  and  Physiological  Chemistry  in  the  University  of 
Utah  in  the  year  1910-11. 

He  is  a  member  of  the  Phi  Beta  Kappa,  Phi  Lambda  Upsilon,  Gamma 
Alpha  Graduate  Scientific  Fraternity,  Sigma  XI,  American  Chemical  So- 
ciety, American  Association  for  the  Advancement  of  Science,  American 
Society  of  Animal  Nutrition,  and  American  Society  of  Biological  Chemists. 

PUBLICATIONS. 

1.  "The  Diastatic  Enzyme  of    Ripening  Meat"    (with   A.  W.  Peters). 
Proc.  Am.  Soc.  Biol.  Chem.,  i,  176  (1909). 

2.  "Studies  in  Fasting"  (with  P.  E.  Howe  and  P.  B.  Hawk) .     Ibid.,  May, 
1910. 

3.  "The  Utilization  of  Ingested  Fat  under  the  Influence  of  Copious  and 
Moderate  Water  Drinking  with  Meals"  (with  P.  B.  Hawk).     Ibid.,  Vol.  II, 
p.  xiv  (1911). 

4.  "A  Method  for  the  Determination  of  Bacterial  Nitrogen  in  Feces" 
(with  P.  B.  Hawk).     Ibid.,  Vol.  II,  p.  xiv  (1911). 

5.  "The  Influence  of  Water  Drinking  with  Meals  upon  the  Utilization  of 
Proteins,  Fats  and  Carbohydrates"  (with  P.  B.  Hawk).     Proceedings,  2nd 
International  Congress  of  Alimentary  Hygiene  and  of  the  Rational  Feed- 
ing of  Man,  Vol.  i,  Section  II,  p.  30  (1911). 

6.  "Nitrogen  Partition  of  Two  Men  through  Seven-Day  Fasts  following 
the  Prolonged  Ingestion  of  a  Low-protein  Diet ;  Supplemented  by  Com- 
parative Data  from  the  Subsequent  Feeding  Period"  (with  P.  E-  Howe  and 
P.  B.  Hawk).     /.  Am.  Chem.  Soc.,  33,  568-598  (1911). 

7.  "A  Method  for  the  Quantitative  Determination  of  Fecal  Bacteria" 
(with  P.  B.  Hawk).     Journal  of  Experimental  Medicine,  14,  433  (1911). 

8.  "The  Influence  of  an  Excessive  Water  Ingestion  on  a  Dog  after  a 
Prolonged  Fast"  (with  P.  E.  Howe  and  P.  B.  Hawk).     Journal  of  Biologi- 
cal Chem.,  10,  (1911). 


^ALIFORN 


